Basic Information
| Provider Information | |||||||||
| NPI: | 1104214238 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAN N NGUYEN DO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3750 CONVOY ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921113738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582788301 | ||||||||
| FaxNumber: | 8582781708 | ||||||||
| Practice Location | |||||||||
| Address1: | 3750 CONVOY ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921113738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582788301 | ||||||||
| FaxNumber: | 8582781708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2014 | ||||||||
| LastUpdateDate: | 12/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | LAN | ||||||||
| AuthorizedOfficialMiddleName: | NGOC | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6193726377 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0801X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
No ID Information.