Provider Demographics
NPI:1952794059
Name:NGUYEN, JOHN (PT)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 E 2ND ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-865-2565
Mailing Address - Fax:909-865-2955
Practice Address - Street 1:795 E 2ND ST
Practice Address - Street 2:SUITE 4
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3779
Practice Address - Fax:909-620-1048
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42342252Y00000X
CAPT42342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency