Provider Demographics
NPI:1457351090
Name:YOUNG-NGUYEN, SERENA (MD)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:
Last Name:YOUNG-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 1:701 E 28TH ST STE 117
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2772
Mailing Address - Country:US
Mailing Address - Phone:562-426-9890
Mailing Address - Fax:562-426-7809
Practice Address - Street 1:701 E 28TH ST STE 117
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2772
Practice Address - Country:US
Practice Address - Phone:562-426-9890
Practice Address - Fax:562-426-7809
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48372207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG48372OtherSTATE LECENSE
CA954721073OtherTRICARE
CAG4837270OtherBLUE CROSS/BLUE SHIELD
CA00G483720Medicaid
CAG48372OtherSTATE LECENSE
CAG4837270OtherBLUE CROSS/BLUE SHIELD