Provider Demographics
NPI:1679519821
Name:NGUYEN, TUAN XUAN (MD)
Entity Type:Individual
Prefix:MR
First Name:TUAN XUAN
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 1:14221 EUCLID ST
Mailing Address - Street 2:STE H
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4991
Mailing Address - Country:US
Mailing Address - Phone:714-530-2420
Mailing Address - Fax:714-530-2478
Practice Address - Street 1:14221 EUCLID ST
Practice Address - Street 2:STE H
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4991
Practice Address - Country:US
Practice Address - Phone:714-530-2420
Practice Address - Fax:714-530-2478
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ08624ZOtherBLUE SHIELD
CA00A486360Medicaid
ZZZ08624ZOtherBLUE SHIELD
CAA48636Medicare ID - Type Unspecified