Provider Demographics
NPI:1841234952
Name:NGUYEN, SI VAN (MD)
Entity Type:Individual
Prefix:
First Name:SI
Middle Name:VAN
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 1:2374 E PACIFICA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90220-6214
Mailing Address - Country:US
Mailing Address - Phone:310-225-3244
Mailing Address - Fax:310-698-7054
Practice Address - Street 1:12601 GARDEN GROVE BLVD
Practice Address - Street 2:PATHOLOGY DEPT.
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1908
Practice Address - Country:US
Practice Address - Phone:949-874-0827
Practice Address - Fax:310-698-7054
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48904207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A489040Medicaid
CA00A489040Medicaid
CAWA48904EMedicare PIN
CAWA48904IMedicare PIN
CAWA48904KMedicare PIN
CAWA48904FMedicare PIN
CAWA48904GMedicare PIN
CAWA48904JMedicare PIN
CAWA48904HMedicare PIN