Provider Demographics
NPI:1306945365
Name:NGUYEN, DUC (MD)
Entity type:Individual
Prefix:DR
First Name:DUC
Middle Name:
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 1:2650 JONES WAY
Mailing Address - Street 2:#7
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065
Mailing Address - Country:US
Mailing Address - Phone:805-520-1577
Mailing Address - Fax:805-520-8091
Practice Address - Street 1:2650 JONES WAY
Practice Address - Street 2:#7
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:805-520-1577
Practice Address - Fax:805-520-8091
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53620207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A536201Medicaid
G72721Medicare UPIN
CA00A536201Medicaid