Provider Demographics
NPI:1356385025
Name:NGUYEN, TIEN TRONG (MD)
Entity type:Individual
Prefix:
First Name:TIEN
Middle Name:TRONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11190 WARNER AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4019
Mailing Address - Country:US
Mailing Address - Phone:714-433-2000
Mailing Address - Fax:714-433-2901
Practice Address - Street 1:11190 WARNER AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4019
Practice Address - Country:US
Practice Address - Phone:714-433-2000
Practice Address - Fax:714-433-2901
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81962207X00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G819620Medicaid
CABW766ZMedicare PIN
CAWG81962AMedicare PIN