Healthcare Provider Details

I. General information

NPI: 1629397799
Provider Name (Legal Business Name): THAO THI NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 W MACARTHUR BLVD GME OFFICE
OAKLAND CA
94611-5642
US

IV. Provider business mailing address

280 W MACARTHUR BLVD GME OFFICE
OAKLAND CA
94611-5642
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-7867
  • Fax: 510-752-1571
Mailing address:
  • Phone: 510-752-7867
  • Fax: 510-752-1571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA 110663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: