Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95015196 | CA |
NPI | 1033721923 |
---|---|
Provider Name | Tim Nguyen |
First Address | Pasadena, CA 91106-5364 |
Second Address | Pasadena, CA 91106-5364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2020 |
Last Update Date | 17/09/2020 |