Provider Demographics
NPI:1942471941
Name:TRUNG MINH NGUYEN, MD, INC
Entity Type:Organization
Organization Name:TRUNG MINH NGUYEN, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CANDYCE
Authorized Official - Middle Name:THU MINH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-444-0303
Mailing Address - Street 1:11180 WARNER AVENUE
Mailing Address - Street 2:SUITE 151
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-444-0303
Mailing Address - Fax:714-444-2047
Practice Address - Street 1:11180 WARNER AVENUE
Practice Address - Street 2:SUITE 151
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-444-0303
Practice Address - Fax:714-444-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079014156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G790140Medicaid
G79014Medicare PIN
F84625Medicare UPIN
4383690001Medicare NSC