Provider Demographics
NPI:1538315981
Name:NGUYEN, LONG H (MD)
Entity Type:Individual
Prefix:DR
First Name:LONG
Middle Name:H
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 1:3043 RACETRACK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2462
Mailing Address - Country:US
Mailing Address - Phone:858-869-5273
Mailing Address - Fax:
Practice Address - Street 1:3043 RACETRACK VIEW DR
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2462
Practice Address - Country:US
Practice Address - Phone:858-869-5273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 98451207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538315981Medicaid
CABQ213WMedicare PIN
CA1538315981Medicaid
CABQ213SMedicare PIN