Provider Demographics
NPI:1407951890
Name:NGUYEN MEDICAL GROUP INC APC
Entity Type:Organization
Organization Name:NGUYEN MEDICAL GROUP INC APC
Other - Org Name:SUN CITY MEDICAL GROUP INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-672-4900
Mailing Address - Street 1:29826 HAUN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6546
Mailing Address - Country:US
Mailing Address - Phone:951-672-4900
Mailing Address - Fax:951-301-0025
Practice Address - Street 1:29826 HAUN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-6547
Practice Address - Country:US
Practice Address - Phone:951-672-4900
Practice Address - Fax:951-301-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72564OtherMEDICAL LICENSE
CA=========OtherEIN NUMBER
CA=========OtherEIN NUMBER
CAH42082Medicare UPIN