Provider Demographics
NPI:1124481809
Name:NGUYEN, AMIE (MD)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
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 1:320 N CENTRAL AVE UNIT 520
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2971
Mailing Address - Country:US
Mailing Address - Phone:310-951-8512
Mailing Address - Fax:
Practice Address - Street 1:1131 N PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2358
Practice Address - Country:US
Practice Address - Phone:818-558-5828
Practice Address - Fax:888-717-1542
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA152137207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program