Provider Demographics
NPI:1720090921
Name:NGUYEN, DOANH ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:DOANH
Middle Name:ANDREW
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 1:10760 WARNER AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3857
Mailing Address - Country:US
Mailing Address - Phone:714-593-5356
Mailing Address - Fax:714-593-5366
Practice Address - Street 1:10760 WARNER AVE STE 201
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3857
Practice Address - Country:US
Practice Address - Phone:714-593-5356
Practice Address - Fax:714-593-5366
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G808140Medicaid
CAG80814Medicare ID - Type Unspecified
CA00G808140Medicaid