Healthcare Provider Details

I. General information

NPI: 1356802359
Provider Name (Legal Business Name): DR. ALAN TRIEU NGUYEN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 03/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 W SHAW AVE
FRESNO CA
93722-6209
US

IV. Provider business mailing address

6245 44TH ST
SACRAMENTO CA
95824-3830
US

V. Phone/Fax

Practice location:
  • Phone: 855-339-1066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number77599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: