Provider Demographics
NPI:1609839299
Name:NGUYEN, TAN THE (MD)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:THE
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12865 MAIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-8205
Mailing Address - Country:US
Mailing Address - Phone:800-760-5520
Mailing Address - Fax:800-760-5520
Practice Address - Street 1:12865 MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-8205
Practice Address - Country:US
Practice Address - Phone:800-768-1977
Practice Address - Fax:800-768-1977
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine