Healthcare Provider Details

I. General information

NPI: 1114126927
Provider Name (Legal Business Name): TAM-AN NGUYEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 10/26/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 MISSOURI FLAT RD
PLACERVILLE CA
95667-6269
US

IV. Provider business mailing address

5106 CAMANCHE WAY
EL DORADO HILLS CA
95762-6565
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-7700
  • Fax:
Mailing address:
  • Phone: 510-717-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: