Provider Demographics
NPI:1043493612
Name:NGUYEN, KEN (PHN, RN)
Entity type:Individual
Prefix:MR
First Name:KEN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2316
Mailing Address - Country:US
Mailing Address - Phone:714-972-3714
Mailing Address - Fax:714-972-3744
Practice Address - Street 1:1540 E 1ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-6341
Practice Address - Country:US
Practice Address - Phone:714-972-3714
Practice Address - Fax:714-972-3744
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546827163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health