Provider Demographics
NPI:1326041823
Name:NGUYEN, HUY DUC (DPM)
Entity Type:Individual
Prefix:DR
First Name:HUY
Middle Name:DUC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-2606
Mailing Address - Country:US
Mailing Address - Phone:760-446-3800
Mailing Address - Fax:760-446-3899
Practice Address - Street 1:1541 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2606
Practice Address - Country:US
Practice Address - Phone:760-446-3800
Practice Address - Fax:760-446-3899
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4129213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
93555B112OtherWPS TRICARE
000E41290OtherBLUE SHIELD
E4129OtherIMG MEDI-CAL MANAGED CARE
480030266OtherRAILROAD MEDICARE
000E41290OtherBLUE CROSS
000E41290OtherCOMMERCIAL
0616650001OtherDME
CA0103OtherJOHN DEERE
CA000E41280Medicaid
666611OtherAHI HEALTH LINK
666611OtherAHI HEALTH LINK
93555B112OtherWPS TRICARE
CA000E41291Medicare PIN