Provider Demographics
NPI:1225065428
Name:NGUYEN, DIANE THUY TU (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:THUY TU
Last Name:NGUYEN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:10362 BOLSA AVENUE
Mailing Address - Street 2:BOLSA MEDICAL GROUP
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6763
Mailing Address - Country:US
Mailing Address - Phone:714-531-2091
Mailing Address - Fax:714-531-1403
Practice Address - Street 1:10362 BOLSA AVENUE
Practice Address - Street 2:BOLSA MEDICAL GROUP
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6763
Practice Address - Country:US
Practice Address - Phone:714-531-2091
Practice Address - Fax:714-531-1403
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-12-12
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Provider Licenses
StateLicense IDTaxonomies
CAA84273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A842730Medicaid
CA00A842730Medicaid
CAWA84273AMedicare ID - Type Unspecified