Provider Demographics
NPI:1962099085
Name:NGUYEN, UYEN T (OTD)
Entity type:Individual
Prefix:
First Name:UYEN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16859 MCCORMICK ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1021
Mailing Address - Country:US
Mailing Address - Phone:818-943-6100
Mailing Address - Fax:
Practice Address - Street 1:16859 MCCORMICK ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1021
Practice Address - Country:US
Practice Address - Phone:818-943-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8101225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics