Provider Demographics
NPI:1083626212
Name:NGHIEM, ELIZABETH Y (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:Y
Last Name:NGHIEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11160 WARNER AVE
Mailing Address - Street 2:SUITE 323
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4008
Mailing Address - Country:US
Mailing Address - Phone:714-751-7002
Mailing Address - Fax:714-751-9340
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:SUITE 323
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4008
Practice Address - Country:US
Practice Address - Phone:714-751-7002
Practice Address - Fax:714-751-9340
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62911207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A629110Medicaid
CAH52051Medicare UPIN
CA00A629110Medicaid