Provider Demographics
NPI:1316939481
Name:NGUYEN, MYDUYEN (MD)
Entity type:Individual
Prefix:MS
First Name:MYDUYEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 EUCLID ST
Mailing Address - Street 2:DEPT. PICU
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4004
Mailing Address - Country:US
Mailing Address - Phone:714-966-7253
Mailing Address - Fax:714-966-3354
Practice Address - Street 1:17100 EUCLID ST
Practice Address - Street 2:DEPT. PICU
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4004
Practice Address - Country:US
Practice Address - Phone:714-966-7253
Practice Address - Fax:714-966-3354
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics