Provider Demographics
NPI:1740563055
Name:KELVIN H NGUYEN FOOT & ANKLE CORPORATION
Entity Type:Organization
Organization Name:KELVIN H NGUYEN FOOT & ANKLE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:TANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-310-4507
Mailing Address - Street 1:10091 NORTHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7535
Mailing Address - Country:US
Mailing Address - Phone:626-310-4507
Mailing Address - Fax:626-532-8733
Practice Address - Street 1:210 N GARFIELD AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1746
Practice Address - Country:US
Practice Address - Phone:626-310-4507
Practice Address - Fax:626-532-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4912213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFM794AMedicare PIN
CA6684850001Medicare NSC
CAEH310AMedicare PIN