Provider Demographics
NPI:1255391181
Name:NGUYEN, YTHANH DUY (MD)
Entity type:Individual
Prefix:DR
First Name:YTHANH
Middle Name:DUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 FOOTHILL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7199
Mailing Address - Country:US
Mailing Address - Phone:909-579-6753
Mailing Address - Fax:909-694-1045
Practice Address - Street 1:999 SAN BERNARDINO RD
Practice Address - Street 2:SAN ANTONIO COMMUNITY HOSPITAL
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4920
Practice Address - Country:US
Practice Address - Phone:562-236-3432
Practice Address - Fax:909-944-5904
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84989207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A849890Medicaid
CA00A849890Medicaid
CAI35372Medicare ID - Type Unspecified