Provider Demographics
NPI:1518992544
Name:NGUYEN, DUC VAN (MD)
Entity Type:Individual
Prefix:
First Name:DUC
Middle Name:VAN
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 1:8748 VALLEY BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1761
Mailing Address - Country:US
Mailing Address - Phone:626-288-3306
Mailing Address - Fax:626-288-9444
Practice Address - Street 1:8748 VALLEY BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1761
Practice Address - Country:US
Practice Address - Phone:626-288-3306
Practice Address - Fax:626-288-9444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42546207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE46907Medicare UPIN