Provider Demographics
NPI:1992032395
Name:NGUYEN, VU THANH (MD)
Entity Type:Individual
Prefix:
First Name:VU
Middle Name:THANH
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 1:12302 GARDEN GROVE BLVD
Mailing Address - Street 2:STE 27
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1834
Mailing Address - Country:US
Mailing Address - Phone:714-530-2772
Mailing Address - Fax:714-530-7424
Practice Address - Street 1:12302 GARDEN GROVE BLVD
Practice Address - Street 2:STE 27
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1834
Practice Address - Country:US
Practice Address - Phone:714-530-2772
Practice Address - Fax:714-530-7424
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine