Provider Demographics
NPI:1538137666
Name:NGUYEN, BAO-THU THI (MD)
Entity Type:Individual
Prefix:
First Name:BAO-THU
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETSY BAO-THU
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4300 LONG BEACH BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2008
Mailing Address - Country:US
Mailing Address - Phone:562-591-7700
Mailing Address - Fax:562-591-1311
Practice Address - Street 1:4300 LONG BEACH BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2008
Practice Address - Country:US
Practice Address - Phone:562-591-7700
Practice Address - Fax:562-591-7700
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62609207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A626090Medicaid
CAG92700Medicare UPIN