Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 94448 | CA |
Y | 213ES0000X | Sports Medicine | 94448 | CA |
NPI | 1417460338 |
---|---|
Provider Name | Tyler Nguyen |
First Address | Canoga Park, CA 91303-2205 |
Second Address | San Diego, CA 92115-2529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2017 |
Last Update Date | 14/11/2017 |