Provider Demographics
NPI:1912063926
Name:NGUYENPHUC, YENCHI (MD)
Entity Type:Individual
Prefix:
First Name:YENCHI
Middle Name:
Last Name:NGUYENPHUC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14571 MAGNOLIA ST
Mailing Address - Street 2:STE 210
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683
Mailing Address - Country:US
Mailing Address - Phone:714-894-3103
Mailing Address - Fax:714-894-6264
Practice Address - Street 1:14571 MAGNOLIA ST
Practice Address - Street 2:STE 210
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683
Practice Address - Country:US
Practice Address - Phone:714-894-3103
Practice Address - Fax:714-894-6264
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63064208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G630640Medicaid