Provider Demographics
NPI:1063685808
Name:T. T. TYLER NGUYEN, M.D., INC.
Entity Type:Organization
Organization Name:T. T. TYLER NGUYEN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOAN
Authorized Official - Middle Name:T TYLER
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-472-9173
Mailing Address - Street 1:PO BOX 2347
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92859-0347
Mailing Address - Country:US
Mailing Address - Phone:562-270-4050
Mailing Address - Fax:800-858-2042
Practice Address - Street 1:2865 ATLANTIC AVE.
Practice Address - Street 2:SUITE # 226
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-270-4050
Practice Address - Fax:800-858-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty