Provider Demographics
NPI:1609078823
Name:NGUYEN, DOMINIC NGON (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:NGON
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PARK CITY COURT
Mailing Address - Street 2:SUITE #11207
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831
Mailing Address - Country:US
Mailing Address - Phone:214-280-7988
Mailing Address - Fax:
Practice Address - Street 1:5501 POWER INN RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-6753
Practice Address - Country:US
Practice Address - Phone:916-387-6929
Practice Address - Fax:916-387-6977
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC526392083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine