Provider Demographics
NPI:1821147224
Name:NGUYEN, ANDREW KHOA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KHOA
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2750 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1050
Mailing Address - Country:US
Mailing Address - Phone:818-241-3125
Mailing Address - Fax:818-241-1652
Practice Address - Street 1:2750 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1050
Practice Address - Country:US
Practice Address - Phone:818-241-3125
Practice Address - Fax:818-241-1652
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78937208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology