Provider Demographics
NPI:1689693749
Name:NGUYEN, TAO T (MD)
Entity Type:Individual
Prefix:DR
First Name:TAO
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3780
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-3780
Mailing Address - Country:US
Mailing Address - Phone:323-583-6516
Mailing Address - Fax:323-583-0802
Practice Address - Street 1:6043 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3118
Practice Address - Country:US
Practice Address - Phone:323-583-6516
Practice Address - Fax:323-583-0802
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA444562080A0000X
CA00A444561208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA444561Medicaid
CA1861587073OtherPEDIATRICS