Provider Demographics
NPI:1467152967
Name:NGUYEN, JENNIFER PHUONG
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13896 DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-3146
Mailing Address - Country:US
Mailing Address - Phone:714-363-7181
Mailing Address - Fax:
Practice Address - Street 1:17732 BEACH BLVD STE G
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6881
Practice Address - Country:US
Practice Address - Phone:714-655-7142
Practice Address - Fax:833-224-5825
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician