Basic Information
| Provider Information | |||||||||
| NPI: | 1326682428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | TUYET | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 N FAIR OAKS AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911033618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266961400 | ||||||||
| FaxNumber: | 6266961450 | ||||||||
| Practice Location | |||||||||
| Address1: | 1125 E 17TH ST STE N452 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927012270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145977214 | ||||||||
| FaxNumber: | 7147273290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2019 | ||||||||
| LastUpdateDate: | 02/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 59081 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.