MEDICARE: DR. TAM HOANG NGUYEN D.O.

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	208M00000X	Hospitalist Physician	20A9636	CA
2	207R00000X	Internal Medicine Physician	20A9636	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20A9636	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1962520478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAM HOANG NGUYEN D.O.

Provider Business Mailing Address
First Line	:	4945 PALEMETTO DUNES CT
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-2131
Country	:	US
Telephone Number	:	408-258-5083
Fax Number	:	408-258-4347

Provider Business Practice Location Address
First Line	:	200 JOSE FIGUERES AVE STE 180
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1586
Country	:	US
Telephone Number	:	408-258-5083
Fax Number	:	408-258-4347

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	09/12/2018

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Directions to “ DR. TAM HOANG NGUYEN D.O.” Practice Location

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