Provider Demographics
NPI:1184149064
Name:NGUYEN, EVELYN LE
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:LE
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 WHITTIER BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15725 WHITTIER BLVD STE 500
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2350
Practice Address - Country:US
Practice Address - Phone:562-448-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2023-09-06
Deactivation Date:2020-12-29
Deactivation Code:
Reactivation Date:2021-01-18
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
CAPA59228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical