Provider Demographics
NPI:1538225156
Name:LIEN HUYEN THI NGUYEN, MD., INC.
Entity type:Organization
Organization Name:LIEN HUYEN THI NGUYEN, MD., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEU
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-957-3901
Mailing Address - Street 1:73 W MARCH LN
Mailing Address - Street 2:STE. C
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5726
Mailing Address - Country:US
Mailing Address - Phone:209-957-3901
Mailing Address - Fax:209-957-2857
Practice Address - Street 1:73 W MARCH LN
Practice Address - Street 2:STE. C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5726
Practice Address - Country:US
Practice Address - Phone:209-957-3901
Practice Address - Fax:209-957-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A373770208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6469530Medicaid
CAGR0079390Medicaid
CA00A373770Medicaid
CA00A601920Medicaid
CAA28368Medicare UPIN
CA00A373770Medicaid
CA6469530Medicaid