Provider Demographics
NPI:1376818872
Name:VINCENT DAT NGUYEN INC.
Entity Type:Organization
Organization Name:VINCENT DAT NGUYEN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-267-7000
Mailing Address - Street 1:5300 BEACH BLVD
Mailing Address - Street 2:110-428
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1250
Mailing Address - Country:US
Mailing Address - Phone:714-267-7000
Mailing Address - Fax:
Practice Address - Street 1:5300 BEACH BLVD
Practice Address - Street 2:110-428
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1250
Practice Address - Country:US
Practice Address - Phone:714-267-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX64290Medicaid
CA00AX64290Medicaid
CAG32889Medicare UPIN