Provider Demographics
NPI:1285376392
Name:NGUYEN, MICHAEL TAM (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TAM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11852 MEDINA DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-2140
Mailing Address - Country:US
Mailing Address - Phone:714-487-9615
Mailing Address - Fax:
Practice Address - Street 1:751 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4601
Practice Address - Country:US
Practice Address - Phone:419-226-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program