Provider Demographics
NPI:1255175196
Name:NGUYEN, ANDREW THOMAS
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:THOMAS
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 1:17657 HEVER CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4473
Mailing Address - Country:US
Mailing Address - Phone:657-212-1333
Mailing Address - Fax:
Practice Address - Street 1:17657 HEVER CIR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4473
Practice Address - Country:US
Practice Address - Phone:657-212-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program