Provider Demographics
NPI:1275636664
Name:NGUYEN, MONIQUE MAIHUONG (OD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:MAIHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CORPORATE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2135
Mailing Address - Country:US
Mailing Address - Phone:949-364-4455
Mailing Address - Fax:949-364-4419
Practice Address - Street 1:777 CORPORATE DR
Practice Address - Street 2:STE 200
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2135
Practice Address - Country:US
Practice Address - Phone:949-364-4455
Practice Address - Fax:949-364-4419
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11931TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91877Medicare UPIN
CAWOP11931AMedicare ID - Type Unspecified