Healthcare Provider Details

I. General information

NPI: 1174226583
Provider Name (Legal Business Name): RICHARD BAO TIEN NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 GLADSTONE DR STE 3
PITTSBURG CA
94565-5123
US

IV. Provider business mailing address

385 14TH ST APT 2506
OAKLAND CA
94612-3872
US

V. Phone/Fax

Practice location:
  • Phone: 925-432-3318
  • Fax: 925-432-0886
Mailing address:
  • Phone: 925-432-3318
  • Fax: 925-432-0886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA211485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: