Healthcare Provider Details

I. General information

NPI: 1558564674
Provider Name (Legal Business Name): DANIELLE THANH-AN NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST SUITE K6 PEDIATRICS
OAKLAND CA
94602
US

IV. Provider business mailing address

39 DOLORES TER
SAN FRANCISCO CA
94110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4887
  • Fax: 510-437-4168
Mailing address:
  • Phone: 917-545-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA93928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: