Provider Demographics
NPI:1770556821
Name:NGUYEN, PHUOC HUU (MD)
Entity type:Individual
Prefix:DR
First Name:PHUOC
Middle Name:HUU
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:909-599-8855
Mailing Address - Fax:909-599-5333
Practice Address - Street 1:1305 W ARROW HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2336
Practice Address - Country:US
Practice Address - Phone:909-599-8855
Practice Address - Fax:909-599-5333
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64287207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16680Medicare ID - Type Unspecified
CAH42833Medicare UPIN