Provider Demographics
NPI:1386626448
Name:NGUYEN, DAT WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:DAT
Middle Name:WILLIAM
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 8005
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-8005
Mailing Address - Country:US
Mailing Address - Phone:858-349-3760
Mailing Address - Fax:619-262-8964
Practice Address - Street 1:5565 GROSSMONT CENTER DR STE 229
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3026
Practice Address - Country:US
Practice Address - Phone:858-349-3760
Practice Address - Fax:619-262-8964
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I08771Medicare UPIN
WA83262AMedicare ID - Type Unspecified