Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0A328550 | CA |
NPI | 1003915125 |
---|---|
Provider Name | Mr. Thuy Thanh Nguyen |
First Address | Garden Grove, CA 92843 |
Second Address | Garden Grove, CA 92843 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0A328550 | MEDI-CAL (01) | CA |