Provider Demographics
NPI:1184716151
Name:NGUYEN, HIEP (MD)
Entity type:Individual
Prefix:
First Name:HIEP
Middle Name:
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:PO BOX 15759
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92175-5759
Mailing Address - Country:US
Mailing Address - Phone:619-582-2079
Mailing Address - Fax:619-582-2075
Practice Address - Street 1:4419 EUCLID AVE STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-4564
Practice Address - Country:US
Practice Address - Phone:619-582-2079
Practice Address - Fax:619-582-2075
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52455207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A524550Medicaid
CAA52455Medicare ID - Type Unspecified
CA00A524550Medicaid