Provider Demographics
NPI:1013078229
Name:NGUYEN-OGHALAI, TRACY UYENTRANG (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:UYENTRANG
Last Name:NGUYEN-OGHALAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:UYENTRANG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-9700
Mailing Address - Fax:
Practice Address - Street 1:1751 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2900
Practice Address - Country:US
Practice Address - Phone:323-442-9700
Practice Address - Fax:713-457-4200
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86114207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045340903Medicaid
TX8A6796Medicare ID - Type Unspecified
TX045340903Medicaid