Provider Demographics
NPI:1073815098
Name:HUNG-ANH BA NGUYEN, M.D., INC
Entity Type:Organization
Organization Name:HUNG-ANH BA NGUYEN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUNG-ANH
Authorized Official - Middle Name:BA
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-858-8515
Mailing Address - Street 1:2828 MILLS PARK DR
Mailing Address - Street 2:STE D
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4711
Mailing Address - Country:US
Mailing Address - Phone:916-858-8515
Mailing Address - Fax:916-858-8246
Practice Address - Street 1:2828 MILLS PARK DR
Practice Address - Street 2:STE D
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4711
Practice Address - Country:US
Practice Address - Phone:916-858-8515
Practice Address - Fax:916-858-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFN361AMedicare PIN