Provider Demographics
NPI:1801935002
Name:NGUYEN, PHUONG T (DC)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 ROSKELLY WAY
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7461
Mailing Address - Country:US
Mailing Address - Phone:562-652-7630
Mailing Address - Fax:714-528-4636
Practice Address - Street 1:9475 HEIL AVE
Practice Address - Street 2:D
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2258
Practice Address - Country:US
Practice Address - Phone:562-652-7630
Practice Address - Fax:714-528-4636
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor