Provider Demographics
NPI:1689625451
Name:NGUYEN, CUONG VIET (MD)
Entity Type:Individual
Prefix:
First Name:CUONG
Middle Name:VIET
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 1:9211 BOLSA AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-898-9966
Mailing Address - Fax:714-898-6174
Practice Address - Street 1:9211 BOLSA AVE
Practice Address - Street 2:STE 220
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-898-9966
Practice Address - Fax:714-898-6174
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA039154207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA0391540Medicaid
CAA0391540Medicaid
CAA039154Medicare ID - Type Unspecified