Provider Demographics
NPI:1164202396
Name:ANDREW NGUYEN DO A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ANDREW NGUYEN DO A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:NEWPORT NEUROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-909-5903
Mailing Address - Street 1:4680 POLARIS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5600
Mailing Address - Country:US
Mailing Address - Phone:702-909-6400
Mailing Address - Fax:855-576-1191
Practice Address - Street 1:280 NEWPORT CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7541
Practice Address - Country:US
Practice Address - Phone:702-909-5903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679004246OtherNPI