Provider Demographics
NPI:1134683683
Name:NGUYEN, CUC NGOCKIM (FNP)
Entity Type:Individual
Prefix:
First Name:CUC
Middle Name:NGOCKIM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 ROSEMEAD BLVD APT 13
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1559
Mailing Address - Country:US
Mailing Address - Phone:626-416-8616
Mailing Address - Fax:
Practice Address - Street 1:11028 LOWER AZUSA RD STE C
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-5406
Practice Address - Country:US
Practice Address - Phone:626-455-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily