Basic Information
Provider Information
NPI: 1508906033
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NGUYEN
FirstName: LIEN
MiddleName: T
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 27799 MEDICAL CENTER RD STE 310
Address2:  
City: MISSION VIEJO
State: CA
PostalCode: 926916400
CountryCode: US
TelephoneNumber: 9493648509
FaxNumber:  
Practice Location
Address1: 27799 MEDICAL CENTER RD STE 310
Address2:  
City: MISSION VIEJO
State: CA
PostalCode: 926916400
CountryCode: US
TelephoneNumber: 9493645090
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/07/2007
LastUpdateDate: 06/24/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/24/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XNP14331CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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