Provider Demographics
NPI:1922232206
Name:NGUYEN, TRUONGSON XUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRUONGSON
Middle Name:XUAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SONNY
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-639-9401
Mailing Address - Fax:714-639-7095
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 410
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-639-9401
Practice Address - Fax:714-639-7095
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101982208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA101982OtherSTATE LICENSE
CAW1514OtherMEDICARE PTAN - TYPE 2
1912919804OtherNPI - TYPE 2
CAGR0003350OtherMEDICAID - GROUP PROVIDER
1912919804OtherNPI - TYPE 2