Provider Demographics
NPI:1285957639
Name:NGUYEN, KELVIN HUY TANG (DPM)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:HUY TANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13310 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2514
Mailing Address - Country:US
Mailing Address - Phone:714-638-2643
Mailing Address - Fax:714-638-0103
Practice Address - Street 1:13310 EUCLID ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2514
Practice Address - Country:US
Practice Address - Phone:714-622-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR66856213ES0103X
CAE-4912213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEH310WMedicare UPIN
CAEH3103Medicare PIN