Provider Demographics
NPI:1114671799
Name:DAT WILLIAM NGUYEN MD INC
Entity Type:Organization
Organization Name:DAT WILLIAM NGUYEN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-300-2340
Mailing Address - Street 1:PO BOX 8005
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-8005
Mailing Address - Country:US
Mailing Address - Phone:619-300-2340
Mailing Address - Fax:949-502-8887
Practice Address - Street 1:6501 LA JOLLA BLVD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-6016
Practice Address - Country:US
Practice Address - Phone:619-300-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty