Provider Demographics
NPI:1568691293
Name:NGUYEN, NGOC THI BICH (MD)
Entity Type:Individual
Prefix:
First Name:NGOC
Middle Name:THI BICH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4302
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:582-499-6171
Practice Address - Street 1:190 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3658
Practice Address - Country:US
Practice Address - Phone:909-882-4788
Practice Address - Fax:909-882-8819
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113921208000000X
MS20713208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA113921OtherMEDICAL LICENSE
CAAPPROVED 2/7/11Medicaid
CAA113921OtherMEDICAL LICENSE
CAFA317YMedicare PIN