Provider Demographics
NPI:1255374187
Name:KHUU, NGUYEN (MD)
Entity type:Individual
Prefix:
First Name:NGUYEN
Middle Name:
Last Name:KHUU
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 1:13622 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-3262
Mailing Address - Country:US
Mailing Address - Phone:714-263-5636
Mailing Address - Fax:
Practice Address - Street 1:1001 N TUSTIN AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3502
Practice Address - Country:US
Practice Address - Phone:714-953-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86064207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA86064BMedicare PIN
CA129750Medicare UPIN