Provider Demographics
NPI:1578582029
Name:NGUYEN, LOAN (MD)
Entity Type:Individual
Prefix:MS
First Name:LOAN
Middle Name:
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 1:1817 SHAW AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4069
Mailing Address - Country:US
Mailing Address - Phone:559-325-9060
Mailing Address - Fax:559-325-9055
Practice Address - Street 1:1817 SHAW AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4069
Practice Address - Country:US
Practice Address - Phone:559-325-9060
Practice Address - Fax:559-325-9055
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6198207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery