Provider Demographics
NPI:1144056383
Name:NGUYENVU, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:NGUYENVU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9942 DANDELION AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2030
Mailing Address - Country:US
Mailing Address - Phone:657-246-8977
Mailing Address - Fax:
Practice Address - Street 1:9942 DANDELION AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2030
Practice Address - Country:US
Practice Address - Phone:657-246-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA98321742G84134Medicaid