Provider Demographics
NPI:1427082890
Name:NGUYEN, THAI-VAN XUAN (MD)
Entity type:Individual
Prefix:DR
First Name:THAI-VAN
Middle Name:XUAN
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 1:10861 CHERRY STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5403
Mailing Address - Country:US
Mailing Address - Phone:562-493-1011
Mailing Address - Fax:562-594-9226
Practice Address - Street 1:10861 CHERRY STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5403
Practice Address - Country:US
Practice Address - Phone:562-493-1011
Practice Address - Fax:562-594-9226
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72892207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092040Medicaid
CAW076AMedicare PIN
CAW076BMedicare PIN
CAF72037Medicare UPIN