Provider Demographics
NPI:1760623847
Name:TUAN XUAN NGUYEN, MD, A PROF CORP.
Entity Type:Organization
Organization Name:TUAN XUAN NGUYEN, MD, A PROF CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN XUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-530-2420
Mailing Address - Street 1:14221 N. EUCLID ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4991
Mailing Address - Country:US
Mailing Address - Phone:714-530-2420
Mailing Address - Fax:714-530-2478
Practice Address - Street 1:14221 N. EUCLID ST
Practice Address - Street 2:SUITE H
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4991
Practice Address - Country:US
Practice Address - Phone:714-530-2420
Practice Address - Fax:714-530-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A486360Medicaid
CAZZZ08624ZOtherBLUE SHIELD
CAZZZ08624ZOtherBLUE SHIELD
CAF89504Medicare UPIN