Provider Demographics
NPI:1447293493
Name:NGUYEN, THAI QUANG (MD)
Entity type:Individual
Prefix:
First Name:THAI
Middle Name:QUANG
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 1:14558 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5750
Mailing Address - Country:US
Mailing Address - Phone:174-531-5056
Mailing Address - Fax:174-531-3488
Practice Address - Street 1:14558 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5750
Practice Address - Country:US
Practice Address - Phone:174-531-5056
Practice Address - Fax:174-531-3488
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39322207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39322Medicare ID - Type UnspecifiedMEDICAL DOCTOR