Provider Demographics
NPI:1851400527
Name:NGUYEN, BAC HAI (MD)
Entity Type:Individual
Prefix:
First Name:BAC
Middle Name:HAI
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 1:933 S SUNSET AVENUE
Mailing Address - Street 2:SUITE # 307
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-962-6811
Mailing Address - Fax:626-960-9520
Practice Address - Street 1:933 S SUNSET AVENUE
Practice Address - Street 2:SUITE # 307
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-962-6811
Practice Address - Fax:626-960-9520
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79012207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG79012OtherPTAN
CA00G790120Medicaid
CAG79012OtherPTAN