Provider Demographics
NPI:1124041256
Name:HOWELL, THU NGUYEN (MD)
Entity Type:Individual
Prefix:DR
First Name:THU
Middle Name:NGUYEN
Last Name:HOWELL
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 1:2222 NEILSON WAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2281
Mailing Address - Country:US
Mailing Address - Phone:909-496-6944
Mailing Address - Fax:
Practice Address - Street 1:6020 SEABLUFF DR
Practice Address - Street 2:SUITE 1
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2252
Practice Address - Country:US
Practice Address - Phone:310-862-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A77900Medicaid
CA00A77900Medicaid