Provider Demographics
NPI:1831194539
Name:NGUYEN, NGHIA XUAN (MD)
Entity type:Individual
Prefix:
First Name:NGHIA
Middle Name:XUAN
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 1:17822 BEACH BLVD.
Mailing Address - Street 2:200
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647
Mailing Address - Country:US
Mailing Address - Phone:714-847-9677
Mailing Address - Fax:714-847-9679
Practice Address - Street 1:17822 BEACH BLVD.
Practice Address - Street 2:200
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647
Practice Address - Country:US
Practice Address - Phone:714-847-9677
Practice Address - Fax:714-847-9679
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82384207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH98102Medicare UPIN
CAW19030Medicare ID - Type Unspecified