Provider Demographics
NPI:1679810907
Name:NGUYEN, STEVEN D (MPA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12912 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4835
Mailing Address - Country:US
Mailing Address - Phone:714-461-3687
Mailing Address - Fax:714-591-5015
Practice Address - Street 1:12966 EUCLID ST STE 495
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-9209
Practice Address - Country:US
Practice Address - Phone:714-461-3687
Practice Address - Fax:714-591-5015
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner