Healthcare Provider Details

I. General information

NPI: 1144859752
Provider Name (Legal Business Name): REGINALD NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 GRANT RD
MOUNTAIN VIEW CA
94040-4302
US

IV. Provider business mailing address

505 PARNASSUS AVE RM M24
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 650-940-7055
  • Fax:
Mailing address:
  • Phone: 415-353-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA189843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: