Provider Demographics
NPI:1700959343
Name:NGUYEN, KHANG MANH (MD)
Entity Type:Individual
Prefix:DR
First Name:KHANG
Middle Name:MANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5454 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5442
Mailing Address - Country:US
Mailing Address - Phone:310-217-7328
Mailing Address - Fax:310-352-3111
Practice Address - Street 1:14112 S KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3018
Practice Address - Country:US
Practice Address - Phone:310-217-7328
Practice Address - Fax:310-352-3111
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA447902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE50617Medicare UPIN