Provider Demographics
NPI:1548272917
Name:DAT MANH NGUYEN MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DAT MANH NGUYEN MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAT
Authorized Official - Middle Name:MANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-531-2548
Mailing Address - Street 1:14536 BROOKHURST ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5787
Mailing Address - Country:US
Mailing Address - Phone:714-531-2548
Mailing Address - Fax:714-531-2450
Practice Address - Street 1:14536 BROOKHURST ST
Practice Address - Street 2:SUITE #102
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5787
Practice Address - Country:US
Practice Address - Phone:714-531-2548
Practice Address - Fax:714-531-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36056207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A360562Medicaid
A27976Medicare UPIN
CAA36056Medicare ID - Type Unspecified