Healthcare Provider Details

I. General information

NPI: 1932761699
Provider Name (Legal Business Name): KATHERINE NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 LLEWELLYN AVE
CAMPBELL CA
95008-1940
US

IV. Provider business mailing address

251 LLEWELLYN AVE
CAMPBELL CA
95008-1940
US

V. Phone/Fax

Practice location:
  • Phone: 408-507-0191
  • Fax:
Mailing address:
  • Phone: 408-507-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number120656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: