Provider Demographics
NPI:1659394419
Name:NGUYEN, QUOC AI (MD)
Entity Type:Individual
Prefix:
First Name:QUOC
Middle Name:AI
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 1:13362 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-3153
Mailing Address - Country:US
Mailing Address - Phone:714-534-4471
Mailing Address - Fax:714-534-4481
Practice Address - Street 1:13362 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-3153
Practice Address - Country:US
Practice Address - Phone:714-534-4471
Practice Address - Fax:714-534-4481
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75928207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G759280Medicaid
CAUENT1009OtherMONARCH
CA00G759280OtherBLUE SHIELD
CAG28207Medicare UPIN
CA00G759280OtherBLUE SHIELD
CA00G759280Medicaid