Provider Demographics
NPI:1427018456
Name:NGUYEN, J DUC NGOC (MD)
Entity Type:Individual
Prefix:
First Name:J DUC
Middle Name:NGOC
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 1:8110 MANGO AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3603
Mailing Address - Country:US
Mailing Address - Phone:909-822-1164
Mailing Address - Fax:909-357-2235
Practice Address - Street 1:8110 MANGO AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3603
Practice Address - Country:US
Practice Address - Phone:909-822-1164
Practice Address - Fax:909-357-2235
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00624360Medicaid
CA00624360Medicaid