Provider Demographics
NPI:1437730777
Name:NGUYEN, FRANK (PA)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 E HADRIANS CRES
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3919
Mailing Address - Country:US
Mailing Address - Phone:224-616-8804
Mailing Address - Fax:
Practice Address - Street 1:13768 ROSWELL AVE STE 118&218
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-591-8200
Practice Address - Fax:866-701-9305
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59252363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA59252OtherPHYSICIAN ASSISTANT BOARD
1172142OtherNCCPA