Provider Demographics
NPI:1669436002
Name:NGUYEN, TRI MINH (MD)
Entity type:Individual
Prefix:DR
First Name:TRI
Middle Name:MINH
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 1:11100 WARNER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7506
Mailing Address - Country:US
Mailing Address - Phone:714-435-1500
Mailing Address - Fax:714-435-1501
Practice Address - Street 1:11100 WARNER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7506
Practice Address - Country:US
Practice Address - Phone:714-435-1500
Practice Address - Fax:714-435-1501
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78829207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5420010001OtherCIGNA GOVT SERV SUPPLIER
CA00A788290Medicaid
CAWA78829AMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NO.
CAI23756Medicare UPIN
CAW18320Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER