Provider Demographics
NPI:1447275631
Name:NGUYEN, HA SON (MD)
Entity type:Individual
Prefix:
First Name:HA
Middle Name:SON
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 1:1951 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-5321
Mailing Address - Country:US
Mailing Address - Phone:562-218-8778
Mailing Address - Fax:562-218-1916
Practice Address - Street 1:1951 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5321
Practice Address - Country:US
Practice Address - Phone:562-218-8778
Practice Address - Fax:562-218-1916
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67118207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G671180Medicaid
CAG67118Medicare ID - Type Unspecified
CA00G671180Medicaid