Provider Demographics
NPI:1275859233
Name:NGUYEN, THUYVAN LAM (DO)
Entity Type:Individual
Prefix:
First Name:THUYVAN
Middle Name:LAM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SCENIC AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1445
Mailing Address - Country:US
Mailing Address - Phone:714-436-4444
Mailing Address - Fax:714-436-4415
Practice Address - Street 1:1665 SCENIC AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1443
Practice Address - Country:US
Practice Address - Phone:714-436-4444
Practice Address - Fax:714-436-4415
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine