Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A120467 | CA |
Y | 207NS0135X | Procedural Dermatology | A120467 | CA |
NPI | 1295022259 |
---|---|
Provider Name | Mrs. Hong Nguyen |
First Address | Long Beach, CA 90808-1793 |
Second Address | Long Beach, CA 90808-1793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 15/06/2018 |