Provider Demographics
NPI:1972668291
Name:NGUYEN, VINH XUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VINH
Middle Name:XUAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10050 E. GARVEY AVE
Mailing Address - Street 2:115
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-2088
Mailing Address - Country:US
Mailing Address - Phone:626-448-3550
Mailing Address - Fax:626-448-3549
Practice Address - Street 1:10050 E. GARVEY AVE
Practice Address - Street 2:115
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2088
Practice Address - Country:US
Practice Address - Phone:626-448-3550
Practice Address - Fax:626-448-3549
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A564581Medicaid
CA00A564581Medicaid
CAWA56458AMedicare PIN