Provider Demographics
NPI:1073980843
Name:NGUYEN, TAMMY THU (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:THU
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 W EDINGER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-4339
Mailing Address - Country:US
Mailing Address - Phone:714-641-1610
Mailing Address - Fax:714-641-1146
Practice Address - Street 1:1610 W EDINGER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-4339
Practice Address - Country:US
Practice Address - Phone:714-641-1610
Practice Address - Fax:714-641-1146
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52707363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant