Provider Demographics
NPI:1912204801
Name:NGUYEN, LY HAI
Entity Type:Individual
Prefix:MR
First Name:LY
Middle Name:HAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8281 WOODED BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8022
Mailing Address - Country:US
Mailing Address - Phone:916-687-1171
Mailing Address - Fax:866-571-3818
Practice Address - Street 1:8281 WOODED BROOK DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-8022
Practice Address - Country:US
Practice Address - Phone:916-687-1171
Practice Address - Fax:866-571-3818
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11-00105968343900000X
CA12-00010225343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)