Provider Demographics
NPI:1821164880
Name:NGUYEN, VAN HOANG (PAC)
Entity Type:Individual
Prefix:MRS
First Name:VAN
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16052 WASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1732
Mailing Address - Country:US
Mailing Address - Phone:714-658-7757
Mailing Address - Fax:213-413-1954
Practice Address - Street 1:12555 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1902
Practice Address - Country:US
Practice Address - Phone:714-537-6595
Practice Address - Fax:714-537-2176
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14701363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical