Ethan-Quan H Nguyen, MD

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

G77748 Issued in CA

Practice address

4336 Market St
Riverside, CA 92501-3518

Phone

(951) 682-9293

NPI assigned

Aug 15, 2005

Reactivated

May 5, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Georgetown University School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Raincross Medical Center of Dermatology and Cosmetic Surgery, Inc

  • Procedural Dermatology Physician
  • Riverside, CA
  • NPI 1588612816
  Medicare reassignment NPD
• Riverside Healthcare System, L.P.

  • Rehabilitation Hospital Unit
  • Riverside, CA
  • NPI 1053358010
  NPD (past)
• Uhs Corona Inc

  • Rehabilitation Hospital Unit
  • Corona, CA
  • NPI 1255327920
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375315200000",
    "number": "1104828508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4336 MARKET ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013518",
            "telephone_number": "951-682-9293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4336 MARKET ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013518",
            "telephone_number": "951-682-9293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "ETHAN-QUAN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2013-08-01",
        "deactivation_date": "2006-05-05",
        "reactivation_date": "2006-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G77748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "030454716",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Duong Dai Nguyen, O.D.
• Dustin Nguyen, DO
• Dzien V Nguyen, DDS
• Edlyn Nguyen, O.T.
• Elizabeth Hoangoanh Nguyen, PHARM.D.
• Hanh N Nguyen, PHARMD
• Hannah Nguyen
• Hannah Han Nguyen
• Helen Lan-Huong Nguyen, MD
• Hillary Nguyen

• Procedural Dermatology Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Procedural Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.