Provider Demographics
NPI:1396844411
Name:NGUYEN, NGOC THUY (MD)
Entity type:Individual
Prefix:MRS
First Name:NGOC
Middle Name:THUY
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 1:12302 GARDEN GROVE BLVD #27
Mailing Address - Street 2:
Mailing Address - City:GRDN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843
Mailing Address - Country:US
Mailing Address - Phone:714-530-2772
Mailing Address - Fax:714-530-7424
Practice Address - Street 1:12302 GARDEN GROVE BLVD #27
Practice Address - Street 2:
Practice Address - City:GRDN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843
Practice Address - Country:US
Practice Address - Phone:714-530-2772
Practice Address - Fax:714-530-7424
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0A34740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A34740Medicare ID - Type Unspecified
CAA84690Medicare UPIN