Provider Demographics
NPI:1508885625
Name:NGUYEN, THANH MINH (MD)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:MINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8919 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2609
Mailing Address - Country:US
Mailing Address - Phone:714-893-5511
Mailing Address - Fax:714-893-5514
Practice Address - Street 1:8919 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2609
Practice Address - Country:US
Practice Address - Phone:714-893-5511
Practice Address - Fax:714-893-5514
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56554207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G565540Medicaid
CAG56554Medicare ID - Type Unspecified
CAE36040Medicare UPIN