Provider Demographics
NPI:1861477044
Name:NGUYEN, BANG THE (DO)
Entity Type:Individual
Prefix:
First Name:BANG
Middle Name:THE
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E VALENCIA MESA DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3809
Mailing Address - Country:US
Mailing Address - Phone:714-992-3000
Mailing Address - Fax:
Practice Address - Street 1:101 E VALENCIA MESA DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3809
Practice Address - Country:US
Practice Address - Phone:714-447-5027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9726208M00000X
ORDO21851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR134037Medicaid
OR1407812365OtherNBMC GROUP NPI NUMBER
OR1407812365OtherGROUP NPI NUMBER
ORCD8723OtherRR MEDICARE GROUP NUMBER
OR110186783OtherRR MEDICARE PTAN NUMBER
OR1407812365OtherGROUP NPI NUMBER
OR930635514OtherGROUP TAX ID NUMBER
ORG97302Medicare UPIN
ORCD8723OtherRR MEDICARE GROUP NUMBER