Provider Demographics
NPI:1932666955
Name:NGUYEN, THAO
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9632 ROSEBAY ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3436
Mailing Address - Country:US
Mailing Address - Phone:408-375-2131
Mailing Address - Fax:
Practice Address - Street 1:16040 HARBOR BLVD STE G
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1327
Practice Address - Country:US
Practice Address - Phone:714-531-7930
Practice Address - Fax:714-531-7997
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF02190750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily