Provider Demographics
NPI:1114700655
Name:NGUYEN, TIMOTHY DUONG
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10180 PALO ALTO ST
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1623
Mailing Address - Country:US
Mailing Address - Phone:909-642-3134
Mailing Address - Fax:
Practice Address - Street 1:10180 PALO ALTO ST
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1623
Practice Address - Country:US
Practice Address - Phone:909-642-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program