Basic Information
| Provider Information | |||||||||
| NPI: | 1184066391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | TOMMY | ||||||||
| MiddleName: | MINH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 W CIVIC CENTER DR STE 700 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927014515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144806767 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14140 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926834453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148967566 | ||||||||
| FaxNumber: | 7148967408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2013 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.