Provider Demographics
NPI:1639129711
Name:NGUYEN, TOAN T TYLER (MD)
Entity Type:Individual
Prefix:
First Name:TOAN
Middle Name:T TYLER
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:PO BOX 2347
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92859-0347
Mailing Address - Country:US
Mailing Address - Phone:562-270-4050
Mailing Address - Fax:800-585-2042
Practice Address - Street 1:2865 ATLANTIC AVE
Practice Address - Street 2:SUITE 226
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-270-4050
Practice Address - Fax:800-585-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA65048OtherSTATE LICENSE NO.
CAP00175864OtherCHAMPUS ID. NO.
CA00CA65048OtherB/S PROVIDER NO.
CAA65048Medicare ID - Type UnspecifiedMCARE NO.
CAA65048OtherSTATE LICENSE NO.