Provider Demographics
NPI:1962598425
Name:NGUYEN, TRI THUONG (MD)
Entity type:Individual
Prefix:DR
First Name:TRI
Middle Name:THUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 CONVOY ST. STE T .
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3737
Mailing Address - Country:US
Mailing Address - Phone:858-277-5463
Mailing Address - Fax:858-279-8296
Practice Address - Street 1:4344 CONVOY ST. STE T .
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3737
Practice Address - Country:US
Practice Address - Phone:858-277-5463
Practice Address - Fax:858-279-8296
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79496207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G794960Medicaid
CAG79496Medicare ID - Type Unspecified
CA00G794960Medicaid