Provider Demographics
NPI:1306807789
Name:NGUYEN, TRIET MINH (MD)
Entity type:Individual
Prefix:DR
First Name:TRIET
Middle Name:MINH
Last Name:NGUYEN
Suffix:
Gender:M
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:PO BOX 2247
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92684-2247
Mailing Address - Country:US
Mailing Address - Phone:714-899-0054
Mailing Address - Fax:714-899-0117
Practice Address - Street 1:9286 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5557
Practice Address - Country:US
Practice Address - Phone:714-899-0054
Practice Address - Fax:714-899-0117
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76262207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G762620Medicaid
CAF59875Medicare UPIN
CAG76262Medicare ID - Type UnspecifiedPROVIDER NO.
CA4137770001Medicare NSC