Provider Demographics
NPI:1114201266
Name:CHIDAO NGUYEN, D.O., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHIDAO NGUYEN, D.O., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIDAO
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-786-5061
Mailing Address - Street 1:9353 BOLSA AVE
Mailing Address - Street 2:#E62
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5951
Mailing Address - Country:US
Mailing Address - Phone:909-786-5061
Mailing Address - Fax:
Practice Address - Street 1:9353 BOLSA AVE
Practice Address - Street 2:#E62
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5951
Practice Address - Country:US
Practice Address - Phone:909-786-5061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10338207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty