Basic Information
| Provider Information | |||||||||
| NPI: | 1467442624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN-CLEARY | ||||||||
| FirstName: | THAI | ||||||||
| MiddleName: | CURTIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 N MARTEL AVE | ||||||||
| Address2: | |||||||||
| City: | WEST HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900466611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234365019 | ||||||||
| FaxNumber: | 3234365034 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 N VERMONT AVE | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900276005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236620492 | ||||||||
| FaxNumber: | 3236620196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A86079 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.