Provider Demographics
NPI:1902989064
Name:NGUYEN, LI (MD)
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15751 BROOKHURST ST STE 105
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7567
Mailing Address - Country:US
Mailing Address - Phone:714-775-6256
Mailing Address - Fax:714-775-6256
Practice Address - Street 1:15751 BROOKHURST ST STE 118
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7567
Practice Address - Country:US
Practice Address - Phone:714-775-8728
Practice Address - Fax:714-775-2194
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG638372086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF56430Medicare UPIN