Healthcare Provider Details

I. General information

NPI: 1598617235
Provider Name (Legal Business Name): MINNIE NGUYEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SULLIVAN AVE RM 106
DALY CITY CA
94015-2227
US

IV. Provider business mailing address

1800 SULLIVAN AVE RM 106
DALY CITY CA
94015-2227
US

V. Phone/Fax

Practice location:
  • Phone: 909-485-2661
  • Fax:
Mailing address:
  • Phone: 909-485-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: