Provider Demographics
NPI:1750578126
Name:PHUOC HUU NGUYEN, MD, INC.
Entity type:Organization
Organization Name:PHUOC HUU NGUYEN, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUOC
Authorized Official - Middle Name:HUU
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-969-8688
Mailing Address - Street 1:18760 AMAR RD
Mailing Address - Street 2:PMB # 187
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4169
Mailing Address - Country:US
Mailing Address - Phone:626-969-8688
Mailing Address - Fax:626-812-9473
Practice Address - Street 1:310 N CITRUS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-3957
Practice Address - Country:US
Practice Address - Phone:626-969-8688
Practice Address - Fax:626-812-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64287207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A642870Medicaid
CAW16680Medicare PIN
CAX98413Medicare UPIN