Provider Demographics
NPI:1184781114
Name:NGUYEN, JOSEPHINE (MD)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:TUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MA
Mailing Address - Street 1:20 EXECUTIVE PARK STE 155
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4733
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:800-409-7005
Practice Address - Street 1:39000 BOB HOPE DR DEPT OF
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:949-263-8620
Practice Address - Fax:800-409-7005
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA758252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184781114Medicaid
CA00A758250OtherBCBS OF CA
I50186Medicare UPIN
CA00A758250OtherBCBS OF CA