Provider Demographics
NPI:1366400145
Name:NGUYEN, QUY VAN (MD)
Entity type:Individual
Prefix:
First Name:QUY
Middle Name:VAN
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 1:9126 VALLEY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1987
Mailing Address - Country:US
Mailing Address - Phone:626-573-9003
Mailing Address - Fax:626-573-0641
Practice Address - Street 1:9126 VALLEY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1987
Practice Address - Country:US
Practice Address - Phone:626-573-9003
Practice Address - Fax:626-573-0641
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A446520Medicaid
C59315Medicare UPIN
CA00A446520Medicaid