Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT38204 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT38204 |
NPI | 1043595085 |
---|---|
Provider Name | Mr. Tuan Anh Nick Nguyen |
First Address | Garden Grove, CA 92840-3822 |
Second Address | Irvine, CA 92604-7701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2011 |
Last Update Date | 20/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0PT244540 | BLUE SHIELD PIN (01) | CA |
P13276 | (02) | CA |
PT24454 | PHYSICAL THERAPY BOARD OF CALIFORNIA (01) | CA |
WPT24454A | (05) | CA |