Provider Demographics
NPI:1134123961
Name:NGUYEN, PHUC VINH (MD)
Entity Type:Individual
Prefix:DR
First Name:PHUC
Middle Name:VINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 BOLSA AVE
Mailing Address - Street 2:STE M
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5943
Mailing Address - Country:US
Mailing Address - Phone:714-531-8915
Mailing Address - Fax:714-531-6231
Practice Address - Street 1:9500 BOLSA AVE
Practice Address - Street 2:STE M
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5943
Practice Address - Country:US
Practice Address - Phone:714-531-8915
Practice Address - Fax:714-531-6231
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C506260Medicaid
CAC50626OtherPHUC V NGUYEN MD
CA00C506260Medicaid
CAG13629Medicare UPIN
CAW18112Medicare ID - Type UnspecifiedPHUC V NGUYEN MD INC
CAC50626OtherPHUC V NGUYEN MD