Provider Demographics
NPI:1336111251
Name:NGUYEN, MINH QUANG (DO)
Entity Type:Individual
Prefix:DR
First Name:MINH
Middle Name:QUANG
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:PO BOX 50663
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-0663
Mailing Address - Country:US
Mailing Address - Phone:424-292-3260
Mailing Address - Fax:
Practice Address - Street 1:15401 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-2214
Practice Address - Country:US
Practice Address - Phone:424-292-3260
Practice Address - Fax:424-292-3266
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A77272083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine