Provider Demographics
NPI:1336162858
Name:NGUYEN, THUY THI-MINH (MD)
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:THI-MINH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THUY
Other - Middle Name:THI-MINH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5879 JACKSON PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2435
Mailing Address - Country:US
Mailing Address - Phone:951-283-8553
Mailing Address - Fax:909-941-0940
Practice Address - Street 1:9695 BASELINE RD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1314
Practice Address - Country:US
Practice Address - Phone:909-941-0920
Practice Address - Fax:909-941-0940
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80322207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A803220Medicaid
CA00A803220OtherBLUE SHIELD
CAP00205726OtherRAILROAD MEDICARE
CAP00205726OtherRAILROAD MEDICARE
CA00A803220Medicaid