Basic Information
| Provider Information | |||||||||
| NPI: | 1801958715 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DANIEL D NGUYEN MD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SOUTH VALLEY DERMATOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 N IRWIN ST | ||||||||
| Address2: | |||||||||
| City: | HANSFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595837546 | ||||||||
| FaxNumber: | 5595836031 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 N IRWIN ST | ||||||||
| Address2: | |||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932303814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595837546 | ||||||||
| FaxNumber: | 5595836031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 07/18/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | DUY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5595837546 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | ZZZ29485Z | 01 | CA | MEDICARE GROUP | OTHER |