Provider Demographics
NPI:1124125943
Name:NGUYEN, VANIA THANH (MD)
Entity type:Individual
Prefix:
First Name:VANIA
Middle Name:THANH
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 1:2020 SANTA MONICA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2013
Mailing Address - Country:US
Mailing Address - Phone:310-582-7313
Mailing Address - Fax:310-315-6118
Practice Address - Street 1:12555 W JEFFERSON BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-7032
Practice Address - Country:US
Practice Address - Phone:424-443-5600
Practice Address - Fax:424-443-5606
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087156208000000X
CAA86445208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics