Provider Demographics
NPI:1104819945
Name:NGUYEN, HUNG (MD)
Entity type:Individual
Prefix:DR
First Name:HUNG
Middle Name:
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 1:7227 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3046
Mailing Address - Country:US
Mailing Address - Phone:818-708-7227
Mailing Address - Fax:818-708-3740
Practice Address - Street 1:7227 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3046
Practice Address - Country:US
Practice Address - Phone:818-708-7227
Practice Address - Fax:818-708-3740
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA423032085U0001X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A423030OtherMEDI-CAL PROVIDER
CAA423030Medicare ID - Type UnspecifiedMEDICARE PROVIDER
CA00A423030OtherMEDI-CAL PROVIDER