Provider Demographics
NPI:1629316856
Name:THUAN T NGUYEN A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THUAN T NGUYEN A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THUAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-444-4011
Mailing Address - Street 1:19121 BROOKHURST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2545
Mailing Address - Country:US
Mailing Address - Phone:714-444-4011
Mailing Address - Fax:714-444-2668
Practice Address - Street 1:19121 BROOKHURST ST STE 101
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2545
Practice Address - Country:US
Practice Address - Phone:714-444-4011
Practice Address - Fax:714-444-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA55079OtherMEDICAL LICENSE NUMBER