Provider Demographics
NPI:1326073644
Name:NGUYEN, TAN VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9646 GARVEY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:S EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-4600
Mailing Address - Country:US
Mailing Address - Phone:626-450-0777
Mailing Address - Fax:626-450-0776
Practice Address - Street 1:9646 GARVEY AVE STE 101
Practice Address - Street 2:
Practice Address - City:S EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-4600
Practice Address - Country:US
Practice Address - Phone:626-450-0777
Practice Address - Fax:626-450-0776
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A053027208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00076Medicare UPIN