Provider Demographics
NPI:1740379312
Name:NGUYEN, HUNG QUOC (MD)
Entity type:Individual
Prefix:
First Name:HUNG
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2359 NOGALES ST
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4857
Mailing Address - Country:US
Mailing Address - Phone:626-269-0967
Mailing Address - Fax:860-591-8396
Practice Address - Street 1:400 W MINERAL KING AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6237
Practice Address - Country:US
Practice Address - Phone:626-646-4359
Practice Address - Fax:860-591-8396
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG77936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G779360Medicaid
CAG77936OtherCA MEDICAL LICENSE ISSUED BY MEDICAL BOARD OF CALIFORNIA
CA00G779360Medicaid