Provider Demographics
NPI:1538230024
Name:PHUC VINH NGUYEN M.D., INC.
Entity type:Organization
Organization Name:PHUC VINH NGUYEN M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUC
Authorized Official - Middle Name:VINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-531-8915
Mailing Address - Street 1:9500 BOLSA AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5943
Mailing Address - Country:US
Mailing Address - Phone:714-531-8915
Mailing Address - Fax:714-531-6231
Practice Address - Street 1:9500 BOLSA AVE
Practice Address - Street 2:SUITE M
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5943
Practice Address - Country:US
Practice Address - Phone:714-531-8915
Practice Address - Fax:714-531-6231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50626207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C506260Medicaid
CAC50626OtherPHUC V NGUYEN MD
CAY20973Medicare UPIN
CAW18112Medicare ID - Type UnspecifiedPHUC VINH NGUYEN MD INC
CAC50626OtherPHUC V NGUYEN MD
CAWC50626AMedicare ID - Type UnspecifiedPHUC V NGUYEN MD