Provider Demographics
NPI:1487842365
Name:DUC NGUYEN MD CORP
Entity Type:Organization
Organization Name:DUC NGUYEN MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUC
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-520-1577
Mailing Address - Street 1:1177 ROADRUNNER WAY
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3159
Mailing Address - Country:US
Mailing Address - Phone:805-520-1577
Mailing Address - Fax:805-520-8091
Practice Address - Street 1:1177 ROADRUNNER WAY
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3159
Practice Address - Country:US
Practice Address - Phone:805-520-1577
Practice Address - Fax:805-520-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53620207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A536201Medicaid
CA00A536201Medicaid
CAW15380Medicare PIN