Provider Demographics
NPI:1619931763
Name:NGUYEN, HOA (MD)
Entity Type:Individual
Prefix:DR
First Name:HOA
Middle Name:
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 1:5835 WESTMINSTER BLVD
Mailing Address - Street 2:SUITE # A
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-9109
Mailing Address - Country:US
Mailing Address - Phone:714-898-9770
Mailing Address - Fax:714-373-3361
Practice Address - Street 1:5835 WESTMINSTER BLVD
Practice Address - Street 2:SUITE # A
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-9109
Practice Address - Country:US
Practice Address - Phone:714-898-9770
Practice Address - Fax:714-373-3361
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58722207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G587221Medicaid
CAG58722OtherLICENSE
CABN0681064OtherDEA
CAG58722OtherLICENSE
CA00G587221Medicaid