Provider Demographics
NPI:1215209077
Name:NGUYEN, NAM D (LAC)
Entity Type:Individual
Prefix:
First Name:NAM
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12832 GARDEN GROVE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2014
Mailing Address - Country:US
Mailing Address - Phone:714-467-0293
Mailing Address - Fax:714-467-0298
Practice Address - Street 1:12832 GARDEN GROVE BLVD STE A
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2014
Practice Address - Country:US
Practice Address - Phone:714-467-0293
Practice Address - Fax:714-467-0298
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4965171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist