Provider Demographics
NPI:1477677920
Name:NGUYEN, HIEP NGHIA (RDO)
Entity Type:Individual
Prefix:
First Name:HIEP
Middle Name:NGHIA
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5130
Mailing Address - Country:US
Mailing Address - Phone:626-282-1069
Mailing Address - Fax:626-282-7154
Practice Address - Street 1:132 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5130
Practice Address - Country:US
Practice Address - Phone:626-282-1069
Practice Address - Fax:626-282-7154
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD3757156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD3757OtherREGISTERED DISPENSING OPT
CADX003757FMedicaid
CAOP0197OtherEYEMED INSURANCE