Provider Demographics
NPI:1184720757
Name:NGUYEN, TIM THE
Entity type:Individual
Prefix:DR
First Name:TIM
Middle Name:THE
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:STE 440
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:805-278-9000
Mailing Address - Fax:805-981-7767
Practice Address - Street 1:1851 HOLSER WALK
Practice Address - Street 2:STE 217
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2626
Practice Address - Country:US
Practice Address - Phone:805-278-9000
Practice Address - Fax:805-981-7767
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3928213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPTEN E3928OtherPTEN E3928
CAPTEN E3928OtherPTEN E3928