Healthcare Provider Details

I. General information

NPI: 1013476878
Provider Name (Legal Business Name): QUOC-HAN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE STE 420
MODESTO CA
95350-4567
US

IV. Provider business mailing address

1524 MCHENRY AVE STE 420
MODESTO CA
95350-4567
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-4444
  • Fax: 209-852-2287
Mailing address:
  • Phone: 209-577-4444
  • Fax: 813-916-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA194696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: