Provider Demographics
NPI:1447284526
Name:NGUYEN, HUNG M (DO)
Entity type:Individual
Prefix:DR
First Name:HUNG
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MAX
Other - Middle Name:MANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:12762 ANNETTE CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-6103
Mailing Address - Country:US
Mailing Address - Phone:714-296-6264
Mailing Address - Fax:714-621-0096
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:STE 200
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5021
Practice Address - Country:US
Practice Address - Phone:714-296-6264
Practice Address - Fax:714-621-0096
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX85680Medicaid
CAW19134Medicare ID - Type UnspecifiedMEDICARE GROUP #
CAW20A8568BMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #
CAI27055Medicare UPIN