Provider Demographics
NPI: | 1518395425 |
---|---|
Name: | NGUYEN, VI HUYEN (FNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | VI |
Middle Name: | HUYEN |
Last Name: | NGUYEN |
Suffix: | |
Gender: | F |
Credentials: | FNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 9191 WESTMINSTER AVE |
Mailing Address - Street 2: | SUITE 209 |
Mailing Address - City: | GARDEN GROVE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92844-2751 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-786-5794 |
Mailing Address - Fax: | 714-786-5799 |
Practice Address - Street 1: | 9191 WESTMINSTER AVE |
Practice Address - Street 2: | SUITE 209 |
Practice Address - City: | GARDEN GROVE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92844-2751 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-786-5794 |
Practice Address - Fax: | 714-786-5799 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2013-10-31 |
Last Update Date: | 2014-12-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 23661 | 363LF0000X |
CA | 815201 | 163W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 163W00000X | Nursing Service Providers | Registered Nurse |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | RN815201 | Other | MEDICAL |
CA | CB207380 | Medicare PIN |