Provider Demographics
NPI:1730270380
Name:NGUYEN, TUAN (MD)
Entity type:Individual
Prefix:DR
First Name:TUAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420988
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92142-0988
Mailing Address - Country:US
Mailing Address - Phone:619-563-4040
Mailing Address - Fax:619-563-1204
Practice Address - Street 1:4141 FAIRMOUNT AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1609
Practice Address - Country:US
Practice Address - Phone:858-278-5293
Practice Address - Fax:619-278-5393
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68761207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G687611Medicaid
CAG68761Medicare ID - Type Unspecified
G68761Medicare PIN
CA00G687611Medicaid