Provider Demographics
NPI:1720033889
Name:NGUYEN, TIEN HUY (DO)
Entity Type:Individual
Prefix:
First Name:TIEN
Middle Name:HUY
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8397
Mailing Address - Country:US
Mailing Address - Phone:707-464-8611
Mailing Address - Fax:707-464-8614
Practice Address - Street 1:780 E WASHINGTON BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8397
Practice Address - Country:US
Practice Address - Phone:707-464-8611
Practice Address - Fax:707-464-8614
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8570208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH96861Medicare UPIN