Provider Demographics
NPI:1205193828
Name:NGUYEN, KEN DUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:DUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHANG
Other - Middle Name:DUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6271 ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1562
Mailing Address - Country:US
Mailing Address - Phone:626-898-4560
Mailing Address - Fax:626-898-4561
Practice Address - Street 1:6271 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1562
Practice Address - Country:US
Practice Address - Phone:626-898-4560
Practice Address - Fax:626-898-4561
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA127222207RG0100X, 207RI0008X, 207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Single Specialty