Basic Information
| Provider Information | |||||||||
| NPI: | 1073046926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | DANNY | ||||||||
| MiddleName: | HAI | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 S MAIN ST STE D | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928823407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513398459 | ||||||||
| FaxNumber: | 9513398461 | ||||||||
| Practice Location | |||||||||
| Address1: | 36485 INLAND VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | WILDOMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925959681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513047187 | ||||||||
| FaxNumber: | 9516779739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2017 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 20A17628 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.