Provider Demographics
NPI:1932395142
Name:QUYNAM NGUYEN, MD, INC.
Entity type:Organization
Organization Name:QUYNAM NGUYEN, MD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QUYNAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-373-2412
Mailing Address - Street 1:10808 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 160-127
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3889
Mailing Address - Country:US
Mailing Address - Phone:909-466-7600
Mailing Address - Fax:909-466-7784
Practice Address - Street 1:3200 INLAND EMPIRE BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-5513
Practice Address - Country:US
Practice Address - Phone:909-373-2412
Practice Address - Fax:909-373-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17934103T00000X
CADC19801111NX0100X
CADC9364111NX0100X
CADC17802111NX0100X
CAG56407207R00000X
CAA653112084P0800X
CAA53572207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty