Provider Demographics
NPI:1669429957
Name:NGUYEN, NIEM L (MD)
Entity type:Individual
Prefix:
First Name:NIEM
Middle Name:L
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 1:12900 PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-741-4421
Mailing Address - Fax:562-741-4479
Practice Address - Street 1:1182 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1900
Practice Address - Country:US
Practice Address - Phone:714-399-9222
Practice Address - Fax:714-399-9226
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
106756OtherHEALTH NET ID #
CA00A780880Medicaid
00A780880OtherBLUE SHIELD ID #
00A780880OtherBLUE SHIELD ID #
106756OtherHEALTH NET ID #
H72937Medicare UPIN