Provider Demographics
NPI:1477845972
Name:NGUYEN, TAN DUY (PT)
Entity Type:Individual
Prefix:MR
First Name:TAN
Middle Name:DUY
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17613 COHASSET ST
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2318
Mailing Address - Country:US
Mailing Address - Phone:415-359-5452
Mailing Address - Fax:
Practice Address - Street 1:14201 NORDHOFF ST APT E1
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-1934
Practice Address - Country:US
Practice Address - Phone:415-359-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist