Provider Demographics
NPI:1144330051
Name:NGUYEN, VICTOR V (MD)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 892788
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-2788
Mailing Address - Country:US
Mailing Address - Phone:951-894-4665
Mailing Address - Fax:951-894-4773
Practice Address - Street 1:39765 DATE ST,
Practice Address - Street 2:SUITE 102
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563
Practice Address - Country:US
Practice Address - Phone:951-894-4665
Practice Address - Fax:951-894-4773
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68591174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH29347Medicare UPIN