Healthcare Provider Details

I. General information

NPI: 1871556969
Provider Name (Legal Business Name): HIEN NGOC NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 S MAIN ST
MILPITAS CA
95035-5318
US

IV. Provider business mailing address

429 S MAIN ST
MILPITAS CA
95035-5318
US

V. Phone/Fax

Practice location:
  • Phone: 408-719-1975
  • Fax: 408-719-1979
Mailing address:
  • Phone: 408-719-1975
  • Fax: 408-719-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA55436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: