Provider Demographics
NPI:1720153182
Name:NGUYEN, TAM K (MD)
Entity type:Individual
Prefix:DR
First Name:TAM
Middle Name:K
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19087 CHANDON LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2145
Mailing Address - Country:US
Mailing Address - Phone:714-757-3797
Mailing Address - Fax:714-541-5029
Practice Address - Street 1:12221 BROOKHURST ST STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-2848
Practice Address - Country:US
Practice Address - Phone:714-805-8260
Practice Address - Fax:714-908-8086
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA55848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA55848Medicare ID - Type UnspecifiedPROVIDER NUMBER