Provider Demographics
NPI:1992729933
Name:NGUYEN, THANG PHUOC (MD)
Entity type:Individual
Prefix:
First Name:THANG
Middle Name:PHUOC
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 1:1271 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2043
Mailing Address - Country:US
Mailing Address - Phone:213-386-0214
Mailing Address - Fax:213-386-0215
Practice Address - Street 1:1271 S UNION AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2043
Practice Address - Country:US
Practice Address - Phone:213-386-0214
Practice Address - Fax:213-386-0215
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66089208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH35559Medicare UPIN