Provider Demographics
NPI:1194220913
Name:NGUYEN, JANNETT (MD)
Entity type:Individual
Prefix:
First Name:JANNETT
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 1:10061 ADAMS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4901
Mailing Address - Country:US
Mailing Address - Phone:657-215-8755
Mailing Address - Fax:714-613-1404
Practice Address - Street 1:10061 ADAMS AVE STE 103
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-4901
Practice Address - Country:US
Practice Address - Phone:657-215-8755
Practice Address - Fax:714-613-1404
Is Sole Proprietor?:No
Enumeration Date:2018-03-25
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA163931207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology