Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC30622 | CA |
NPI | 1275724445 |
---|---|
Provider Name | Lee T Nguyen |
First Address | Moreno Valley, CA 92553-4524 |
Second Address | Corona, CA 92882-3060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 05/08/2007 |