Basic Information
Provider Information | |||||||||
NPI: | 1679657449 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NGUYEN | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | Q | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 25050 AVENUE KEARNY | ||||||||
Address2: | STE 208 | ||||||||
City: | VALENCIA | ||||||||
State: | CA | ||||||||
PostalCode: | 913551257 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6614300940 | ||||||||
FaxNumber: | 6612950862 | ||||||||
Practice Location | |||||||||
Address1: | 1001 W WHITTIER BLVD | ||||||||
Address2: | SUITE B | ||||||||
City: | MONTEBELLO | ||||||||
State: | CA | ||||||||
PostalCode: | 906404688 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3237288010 | ||||||||
FaxNumber: | 3238882342 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/25/2006 | ||||||||
LastUpdateDate: | 04/24/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | E4371 | CA | N |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0103X | E4371 | CA | Y |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
ID | Type | State | Issuer | Description | E4371 | 01 | CA | MEDICAL LICENSE# | OTHER |