Provider Demographics
NPI:1245495498
Name:NGUYEN, DUC TIEN (DPM, DC)
Entity type:Individual
Prefix:DR
First Name:DUC
Middle Name:TIEN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14441 BEACH BLVD 225
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5347
Mailing Address - Country:US
Mailing Address - Phone:818-925-0193
Mailing Address - Fax:714-551-1953
Practice Address - Street 1:9355 CHAPMAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2536
Practice Address - Country:US
Practice Address - Phone:818-925-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-26
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4494213EP1101X
CA21758111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No111N00000XChiropractic ProvidersChiropractor