Provider Demographics
NPI:1467564773
Name:TONG, NHUAN NGUYEN (MD)
Entity Type:Individual
Prefix:
First Name:NHUAN
Middle Name:NGUYEN
Last Name:TONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NHUAN
Other - Middle Name:
Other - Last Name:NGUYEN-TONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9091 EDINGER AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7458
Mailing Address - Country:US
Mailing Address - Phone:714-897-5673
Mailing Address - Fax:714-898-6304
Practice Address - Street 1:9091 EDINGER AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7458
Practice Address - Country:US
Practice Address - Phone:714-897-5673
Practice Address - Fax:714-898-6304
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA346701Medicaid