Provider Demographics
NPI:1295420685
Name:NGUYEN, PHUONG ANH NGOC (PA-C)
Entity type:Individual
Prefix:
First Name:PHUONG ANH
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:9631 INGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2923
Mailing Address - Country:US
Mailing Address - Phone:714-331-9772
Mailing Address - Fax:
Practice Address - Street 1:8251 WESTMINSTER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3370
Practice Address - Country:US
Practice Address - Phone:714-465-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant