Provider Demographics
NPI:1750382008
Name:NGUYEN, RANDALL L (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:L
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 1:4300 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2011
Mailing Address - Country:US
Mailing Address - Phone:562-984-7024
Mailing Address - Fax:562-428-7394
Practice Address - Street 1:4300 LONG BEACH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2011
Practice Address - Country:US
Practice Address - Phone:562-984-7024
Practice Address - Fax:562-428-7394
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55189207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A551890Medicaid
WA55189AMedicare ID - Type Unspecified
H16776Medicare UPIN