Healthcare Provider Details

I. General information

NPI: 1396217733
Provider Name (Legal Business Name): TUYEN THI THANH NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KAISER ROSEVILLE HOSPITAL 1600 EUREKA RD
ROSEVILLE CA
95661
US

IV. Provider business mailing address

9160 MADISON AVE APT 100
FAIR OAKS CA
95628-7736
US

V. Phone/Fax

Practice location:
  • Phone: 916-474-7777
  • Fax:
Mailing address:
  • Phone: 916-612-5449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number25012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: