Provider Demographics
NPI:1851390751
Name:NGUYEN, MYANH C (MD)
Entity Type:Individual
Prefix:
First Name:MYANH
Middle Name:C
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 REDONDO AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2325
Mailing Address - Country:US
Mailing Address - Phone:562-429-1200
Mailing Address - Fax:562-429-8070
Practice Address - Street 1:2600 REDONDO AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2325
Practice Address - Country:US
Practice Address - Phone:562-429-1200
Practice Address - Fax:562-429-8070
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836210OtherMEDI CAL #
CAH99610Medicare UPIN