Basic Information
| Provider Information | |||||||||
| NPI: | 1831288406 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | QUOCHU | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2360 PACIFIC AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908063051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629816856 | ||||||||
| FaxNumber: | 5629816851 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 LONG BEACH BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908065062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629816865 | ||||||||
| FaxNumber: | 5625956471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 11/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A7395 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00AX73950 | 05 | CA | MEDICAID |