Provider Demographics
NPI:1740242650
Name:NGUYEN, JOHNNY HOANG (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:HOANG
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 1:499 N EL CAMINO REAL
Mailing Address - Street 2:SUITE C120
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1366
Mailing Address - Country:US
Mailing Address - Phone:760-436-6000
Mailing Address - Fax:
Practice Address - Street 1:499 N EL CAMINO REAL
Practice Address - Street 2:SUITE C120
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1366
Practice Address - Country:US
Practice Address - Phone:760-436-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI19742Medicare UPIN