Provider Demographics
NPI:1285695163
Name:NGHIA XUAN NGUYEN, MD INC
Entity type:Organization
Organization Name:NGHIA XUAN NGUYEN, MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:NGHIA
Authorized Official - Middle Name:XUAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-847-9677
Mailing Address - Street 1:17822 BEACH BLVD.
Mailing Address - Street 2:200
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7190
Mailing Address - Country:US
Mailing Address - Phone:714-847-9677
Mailing Address - Fax:714-847-9679
Practice Address - Street 1:17822 BEACH BLVD.
Practice Address - Street 2:200
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7190
Practice Address - Country:US
Practice Address - Phone:714-847-9677
Practice Address - Fax:714-847-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82384207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH98102Medicare UPIN
CAW19030Medicare PIN