Basic Information
| Provider Information | |||||||||
| NPI: | 1841912771 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | BICH THU | ||||||||
| MiddleName: | THI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11186 STONECRESS AVE | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927082401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495361164 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11100 WARNER AVE STE 218 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927087511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146419696 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2022 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 95022589 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.