Individual provider Active NPI

Stephanie Anh-Hang Nguyen, D.O.

  • Adult Medicine Physician
  • Patton, CA
National Provider Identifier
1114033388
Registry record updated Aug 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
20A7978 Issued in CA
Practice address
3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369
Phone
(909) 425-7679
Fax
(909) 425-6635
NPI assigned
Aug 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X 20A7978 CA Primary

Addresses

Primary practice location

3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369

Mailing address

3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369
Phone (909) 425-7679

Other identifiers 1

IdentifierTypeStateIssuer
00AX79780MedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20051202000565 CA Practitioner - Family Practice 0648290866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Arizona College of Osteopathic Medicine Mid Western University, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Department of State HospitalsGroup PAC ID 9638174238, 275 clinicians

Practice addresses (Care Compare)

11401 Bloomfield Ave
Norwalk, CA 90650-2015
Phone (916) 651-8811

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
7978CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Department of State Hospitals Current Accepting new patients
Department of State Hospitals CurrentSince May 24, 2017 Accepting new patients

Locations

11401 Bloomfield Ave
Norwalk, CA 90650
Phone (562) 863-7011

3102 E Highland Ave
Ofc
Patton, CA 92369
Phone (909) 425-7000

3102 E Highland Ave
Patton, CA 92369
Phone (909) 425-7000

1600 9th St
Ste 150
Sacramento, CA 95814
Phone (916) 651-8811

1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375920000000",
    "number": "1114033388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3102 E. HIGHLAND AVENUE",
            "address_2": "MEDICAL STAFF OFFICE",
            "city": "PATTON",
            "state": "CA",
            "postal_code": "92369",
            "telephone_number": "909-425-7679",
            "fax_number": "909-425-6635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3102 E. HIGHLAND AVENUE",
            "address_2": "MEDICAL STAFF OFFICE",
            "city": "PATTON",
            "state": "CA",
            "postal_code": "92369",
            "telephone_number": "909-425-7679",
            "fax_number": "909-425-6635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "STEPHANIE",
        "middle_name": "ANH-HANG",
        "name_prefix": "Mrs.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2013-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "20A7978",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX79780",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Patton, CA

Sources for this page

Verify at the official NPI Registry.