Provider Demographics
NPI:1255366928
Name:NGUYEN, DUC VAN (MD)
Entity type:Individual
Prefix:DR
First Name:DUC
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:
Practice Address - Street 1:2120 CIENAGA ST
Practice Address - Street 2:
Practice Address - City:OCEANO
Practice Address - State:CA
Practice Address - Zip Code:93445-9016
Practice Address - Country:US
Practice Address - Phone:805-994-2100
Practice Address - Fax:805-994-2197
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836700Medicaid
CA00A836700Medicaid
CAWA83670AMedicare PIN