Provider Demographics
NPI:1316263932
Name:NGUYEN, CHUNG M (LCSW)
Entity type:Individual
Prefix:
First Name:CHUNG
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 KATELLA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6831
Mailing Address - Country:US
Mailing Address - Phone:714-695-5456
Mailing Address - Fax:
Practice Address - Street 1:5212 KATELLA AVE STE 202
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6831
Practice Address - Country:US
Practice Address - Phone:714-695-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW823871041C0700X, 1041C0700X
104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator