Provider Demographics
NPI:1316017353
Name:NGUYEN, DAVID HUU (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HUU
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9246 VALLEY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1922
Mailing Address - Country:US
Mailing Address - Phone:626-641-2119
Mailing Address - Fax:626-517-7732
Practice Address - Street 1:9246 VALLEY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1922
Practice Address - Country:US
Practice Address - Phone:626-641-2119
Practice Address - Fax:626-571-7732
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6867208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86422Medicare UPIN