Healthcare Provider Details

I. General information

NPI: 1952424004
Provider Name (Legal Business Name): STEPHANIE TRAM ANH NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD. U.C. DAVID MEDICAL CENTER
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2516 STOCKTON BLVD. U.C. DAVID MEDICAL CENTER
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-8118
  • Fax: 916-734-0629
Mailing address:
  • Phone: 916-734-8118
  • Fax: 916-734-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA74187
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberA74187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: