Healthcare Provider Details

I. General information

NPI: 1992144992
Provider Name (Legal Business Name): HANH THI NGUYEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANH THI NGUYEN FNP

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10455 S DE ANZA BLVD
CUPERTINO CA
95014-3011
US

IV. Provider business mailing address

2118 CHISIN ST
SAN JOSE CA
95121-3230
US

V. Phone/Fax

Practice location:
  • Phone: 408-996-1911
  • Fax:
Mailing address:
  • Phone: 408-910-4406
  • Fax: 408-238-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number778829
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95000107
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number778829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: