Provider Demographics
NPI:1700959558
Name:NGUYEN, TAM VAN (DC)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13252 CENTURY BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1257
Mailing Address - Country:US
Mailing Address - Phone:714-537-5537
Mailing Address - Fax:714-537-5550
Practice Address - Street 1:13252 CENTURY BLVD STE L
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1257
Practice Address - Country:US
Practice Address - Phone:714-537-5537
Practice Address - Fax:714-537-5550
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor