Provider Demographics
NPI:1083628036
Name:NGUYEN, ANNMARIE TRANG (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNMARIE
Middle Name:TRANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12665 GARDEN GROVE BLVD STE 611
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1920
Mailing Address - Country:US
Mailing Address - Phone:714-539-5225
Mailing Address - Fax:714-539-5213
Practice Address - Street 1:12665 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 611
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1901
Practice Address - Country:US
Practice Address - Phone:714-539-5225
Practice Address - Fax:714-539-5213
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69150261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABI 909OtherMEDICARE ID
CA00G691500Medicaid
CABI 909OtherMEDICARE ID
CABI 909Medicare PIN