Provider Demographics
NPI:1174692560
Name:NGUYEN, LOAN AI (LAC,DOM)
Entity type:Individual
Prefix:DR
First Name:LOAN
Middle Name:AI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LAC,DOM
Other - Prefix:
Other - First Name:LOAN
Other - Middle Name:AI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, DOM
Mailing Address - Street 1:7901 WESTMINSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4001
Mailing Address - Country:US
Mailing Address - Phone:714-893-0882
Mailing Address - Fax:714-898-7052
Practice Address - Street 1:7901 WESTMINSTER BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4001
Practice Address - Country:US
Practice Address - Phone:714-893-0882
Practice Address - Fax:714-898-7052
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3185171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist