Healthcare Provider Details

I. General information

NPI: 1740129113
Provider Name (Legal Business Name): MR. PHUC T NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. GEORGE NGUYEN

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26761 WAUCHULA WAY
HAYWARD CA
94545-3153
US

IV. Provider business mailing address

26761 WAUCHULA WAY
HAYWARD CA
94545-3153
US

V. Phone/Fax

Practice location:
  • Phone: 415-409-9836
  • Fax:
Mailing address:
  • Phone: 415-409-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: