Provider Demographics
NPI:1578663787
Name:NGUYEN, NGOCBICH THI (MD)
Entity Type:Individual
Prefix:
First Name:NGOCBICH
Middle Name:THI
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 1:4060 FOURTH AVE
Mailing Address - Street 2:500
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2116
Mailing Address - Country:US
Mailing Address - Phone:619-298-2900
Mailing Address - Fax:619-260-1919
Practice Address - Street 1:4060 FOURTH AVE
Practice Address - Street 2:500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:619-298-2900
Practice Address - Fax:619-260-1919
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWA77428B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA77428BMedicare ID - Type Unspecified
H78174Medicare UPIN