Provider Demographics
NPI:1598729980
Name:NGUYEN, TOM LE (DO)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:LE
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9146 E. VALLEY BLVD SUITE A
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1920
Mailing Address - Country:US
Mailing Address - Phone:626-571-6908
Mailing Address - Fax:626-571-7732
Practice Address - Street 1:9146 E. VALLEY BLVD SUITE A
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1920
Practice Address - Country:US
Practice Address - Phone:626-571-6908
Practice Address - Fax:626-571-7732
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A9384OtherLICENSE
CABN129VMedicare PIN
CA20A9384OtherLICENSE
CABN129XMedicare PIN