Healthcare Provider Details

I. General information

NPI: 1710463351
Provider Name (Legal Business Name): ANDREW HOANG QUY NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 125C
OAKLAND CA
94605-2454
US

IV. Provider business mailing address

7200 BANCROFT AVE STE 125C
OAKLAND CA
94605-2454
US

V. Phone/Fax

Practice location:
  • Phone: 510-383-5100
  • Fax:
Mailing address:
  • Phone: 510-383-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: