Provider Demographics
NPI:1174608046
Name:NGUYEN, TRUNG X (MD)
Entity type:Individual
Prefix:
First Name:TRUNG
Middle Name:X
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1000
Mailing Address - Fax:
Practice Address - Street 1:681 S PARKER ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4719
Practice Address - Country:US
Practice Address - Phone:714-277-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75649207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G756490Medicaid
CAG75649BMedicare ID - Type Unspecified