Provider Demographics
NPI:1750495933
Name:NGUYEN, CHI (MD)
Entity Type:Individual
Prefix:
First Name:CHI
Middle Name:
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 1:1136 W HEMLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7465
Mailing Address - Country:US
Mailing Address - Phone:559-684-4530
Mailing Address - Fax:559-686-1157
Practice Address - Street 1:922 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2210
Practice Address - Country:US
Practice Address - Phone:559-684-4530
Practice Address - Fax:559-686-1157
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A527310Medicaid
CA00A527310Medicaid
BW555AMedicare PIN