Provider Demographics
NPI:1659504124
Name:THANG DINH NGUYEN, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:THANG DINH NGUYEN, M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HUONG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-434-0404
Mailing Address - Street 1:18255 BROOKHURST ST
Mailing Address - Street 2:STE 100
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6771
Mailing Address - Country:US
Mailing Address - Phone:714-434-0404
Mailing Address - Fax:714-434-0808
Practice Address - Street 1:18255 BROOKHURST ST
Practice Address - Street 2:STE 100
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6771
Practice Address - Country:US
Practice Address - Phone:714-434-0404
Practice Address - Fax:714-434-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty