Provider Demographics
NPI:1508897158
Name:NGUYEN, HOA (MD)
Entity Type:Individual
Prefix:
First Name:HOA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOA
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15651 E. IMPERIAL HWY
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638
Mailing Address - Country:US
Mailing Address - Phone:562-947-9591
Mailing Address - Fax:562-947-8956
Practice Address - Street 1:15651 E. IMPERIAL HWY
Practice Address - Street 2:SUITE 102B
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1628
Practice Address - Country:US
Practice Address - Phone:562-947-9591
Practice Address - Fax:562-947-8956
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954491998OtherITIN