Provider Demographics
NPI:1457329179
Name:NGUYEN, HOANG TRAN (MD)
Entity Type:Individual
Prefix:
First Name:HOANG
Middle Name:TRAN
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 1:4061 REYES ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2723
Mailing Address - Country:US
Mailing Address - Phone:949-387-0239
Mailing Address - Fax:714-531-7997
Practice Address - Street 1:16040 HARBOR BLVD
Practice Address - Street 2:STE. G
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1327
Practice Address - Country:US
Practice Address - Phone:714-531-7930
Practice Address - Fax:714-531-7997
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A803210Medicaid
CA00A803210Medicaid