Provider Demographics
NPI:1306672795
Name:NGUYEN, MICHAEL TRONG BAO
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TRONG BAO
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4302
Mailing Address - Country:US
Mailing Address - Phone:626-552-6342
Mailing Address - Fax:
Practice Address - Street 1:364 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4302
Practice Address - Country:US
Practice Address - Phone:626-552-6342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine