Healthcare Provider Details

I. General information

NPI: 1003141102
Provider Name (Legal Business Name): KHOI DUC NGUYEN MD, DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD
ARCATA CA
95521-4742
US

IV. Provider business mailing address

1295 FULBAR CT
SAN JOSE CA
95132-3022
US

V. Phone/Fax

Practice location:
  • Phone: 408-489-4832
  • Fax:
Mailing address:
  • Phone: 408-489-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A 11589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: