Provider Demographics
NPI:1760672174
Name:THOMAS TOAN NGUYEN MD APC
Entity Type:Organization
Organization Name:THOMAS TOAN NGUYEN MD APC
Other - Org Name:THOMAS NGUYEN MD INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:TOAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-585-1158
Mailing Address - Street 1:1789 W RIO HONDO CT
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-1130
Mailing Address - Country:US
Mailing Address - Phone:559-585-1158
Mailing Address - Fax:559-380-2194
Practice Address - Street 1:307 MALL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5793
Practice Address - Country:US
Practice Address - Phone:559-585-1158
Practice Address - Fax:559-380-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ05702ZMedicare PIN