Provider Demographics
NPI:1063771319
Name:NGUYEN, GRACE HOANG-OANH (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:HOANG-OANH
Last Name:NGUYEN
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 1:4939 WOODFALL DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-7014
Mailing Address - Country:US
Mailing Address - Phone:817-703-3867
Mailing Address - Fax:
Practice Address - Street 1:1532 SAN BERNARDINO AVE STE B7
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3559
Practice Address - Country:US
Practice Address - Phone:909-301-4041
Practice Address - Fax:909-301-4042
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC175546208000000X
GA74858208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics