Provider Demographics
NPI:1851487201
Name:NGUYEN, HUYEN TIFFANY (OD)
Entity Type:Individual
Prefix:DR
First Name:HUYEN
Middle Name:TIFFANY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:SAHARA
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2135 E. ANAHEIM STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804
Mailing Address - Country:US
Mailing Address - Phone:562-621-1457
Mailing Address - Fax:562-621-6458
Practice Address - Street 1:2135 E. ANAHEIM STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-621-1457
Practice Address - Fax:562-621-6458
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9952T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0099520Medicaid