MEDICARE: DR. MINHTAM S NGUYEN M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A45479	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BZ777A	OTHER	CA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457460354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINHTAM S NGUYEN M.D

Provider Business Mailing Address
First Line	:	1340 TULLY ROAD, SUITE 309
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3057
Country	:	US
Telephone Number	:	408-993-8536
Fax Number	:	408-993-8539

Provider Business Practice Location Address
First Line	:	1340 TULLY RD STE 309
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3055
Country	:	US
Telephone Number	:	408-993-8536
Fax Number	:	408-993-8539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/13/2013

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