Provider Demographics
NPI:1508469339
Name:NGUYEN, PAUL PHUC (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:PHUC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 SYRACUSE AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-1908
Mailing Address - Country:US
Mailing Address - Phone:714-209-8650
Mailing Address - Fax:
Practice Address - Street 1:2755 BRISTOL ST STE 130
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5985
Practice Address - Country:US
Practice Address - Phone:714-966-2950
Practice Address - Fax:714-557-2487
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist