Provider Demographics
NPI:1578523049
Name:THANH-VAN NGOC NGUYEN MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:THANH-VAN NGOC NGUYEN MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:THANH-VAN
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-593-5356
Mailing Address - Street 1:10760 WARNER AVE
Mailing Address - Street 2:201
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3845
Mailing Address - Country:US
Mailing Address - Phone:714-593-5356
Mailing Address - Fax:714-593-5366
Practice Address - Street 1:10760 WARNER AVE
Practice Address - Street 2:201
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3845
Practice Address - Country:US
Practice Address - Phone:714-593-5356
Practice Address - Fax:714-593-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85166207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16339Medicare PIN
CAH31539Medicare UPIN