Provider Demographics
NPI:1902078942
Name:NGUYEN, VAN KHANH THI
Entity Type:Individual
Prefix:
First Name:VAN KHANH
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KHANH VAN
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1622 E SEDONA DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3303
Mailing Address - Country:US
Mailing Address - Phone:714-235-6135
Mailing Address - Fax:
Practice Address - Street 1:8599 HAVEN AVE.
Practice Address - Street 2:SUITE 300
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4849
Practice Address - Country:US
Practice Address - Phone:909-620-8180
Practice Address - Fax:909-919-7288
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA880032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology