Provider Demographics
NPI:1366751539
Name:NGUYEN, JENNIFER HONGHANH (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HONGHANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19191 S VERMONT AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1018
Mailing Address - Country:US
Mailing Address - Phone:310-354-4346
Mailing Address - Fax:310-538-1568
Practice Address - Street 1:19191 S VERMONT AVE
Practice Address - Street 2:STE 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1018
Practice Address - Country:US
Practice Address - Phone:310-354-4346
Practice Address - Fax:310-538-1568
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA687079363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner