Provider Demographics
NPI:1922136647
Name:NGUYEN, TONY CHIEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:CHIEN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 COPLEY DR
Mailing Address - Street 2:STE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-7903
Mailing Address - Country:US
Mailing Address - Phone:858-262-6343
Mailing Address - Fax:858-262-6787
Practice Address - Street 1:4761 HOEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7862
Practice Address - Country:US
Practice Address - Phone:707-545-0570
Practice Address - Fax:707-545-0575
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE41516213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E45160Medicaid
CAV02706Medicare UPIN
CA000E45160Medicaid
CAP00640909Medicare PIN
CA000E45160Medicare PIN