Individual
TAN KHAC NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1310 SAN BERNARDINO RD, SUITE 207, UPLAND, CA 91786-4979
(909) 946-8600
(909) 946-8604
Mailing address
1310 SAN BERNARDINO RD, SUITE 207, UPLAND, CA 91786-4979
(909) 946-8600
(909) 946-8604
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
A70331
CA
207NS0135X
Procedural Dermatology Physician
Primary
A70331
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00614352
RAILLROAD MEDICARE
CA
Enumeration date
05/18/2006
Last updated
08/08/2011
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