Provider Demographics
NPI:1225010135
Name:NGUYEN-THIO, CHAU M T (MD)
Entity Type:Individual
Prefix:
First Name:CHAU
Middle Name:M T
Last Name:NGUYEN-THIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHAU
Other - Middle Name:M T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12742 LIMONITE AVE
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9630
Mailing Address - Country:US
Mailing Address - Phone:951-739-2717
Mailing Address - Fax:
Practice Address - Street 1:12742 LIMONITE AVE
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-9630
Practice Address - Country:US
Practice Address - Phone:951-739-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730180415OtherGROUP NPI #
ZZZ31887ZOtherGROUP SITE #
G47783Medicare UPIN
OOG795480Medicare ID - Type Unspecified