Provider Demographics
NPI:1952600850
Name:NGUYEN, JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
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 105
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5574
Mailing Address - Country:US
Mailing Address - Phone:714-892-1313
Mailing Address - Fax:714-891-8799
Practice Address - Street 1:14571 MAGNOLIA ST
Practice Address - Street 2:STE 105
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5574
Practice Address - Country:US
Practice Address - Phone:714-892-1313
Practice Address - Fax:714-891-8799
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 11005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM072ZOtherMEDICARE PTAN