Provider Demographics
NPI:1023873767
Name:NGUYEN, KHANG H
Entity type:Individual
Prefix:MR
First Name:KHANG
Middle Name:H
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JUSTIN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17732 BEACH BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6881
Mailing Address - Country:US
Mailing Address - Phone:714-655-7142
Mailing Address - Fax:
Practice Address - Street 1:17732 BEACH BLVD STE G
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6881
Practice Address - Country:US
Practice Address - Phone:714-655-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician