Provider Demographics
NPI:1679657449
Name:NGUYEN, JAMES Q (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:Q
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25050 AVENUE KEARNY
Mailing Address - Street 2:STE 208
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1257
Mailing Address - Country:US
Mailing Address - Phone:661-430-0940
Mailing Address - Fax:661-295-0862
Practice Address - Street 1:1001 W WHITTIER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4688
Practice Address - Country:US
Practice Address - Phone:323-728-8010
Practice Address - Fax:323-888-2342
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4371213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4371OtherMEDICAL LICENSE#
CAU89395Medicare UPIN
CAE4371Medicare ID - Type UnspecifiedMCARE PROVIDER ID#
CAU89395Medicare UPIN
CA4498170001OtherDMERC ID#
CABN7617674OtherDEA ID#
CA000E43710Medicaid