Healthcare Provider Details

I. General information

NPI: 1619206489
Provider Name (Legal Business Name): VAN-MINH NGUYEN P.A-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 J ST
SACRAMENTO CA
95811-3120
US

IV. Provider business mailing address

2020 J ST
SACRAMENTO CA
95811-3120
US

V. Phone/Fax

Practice location:
  • Phone: 916-341-0576
  • Fax:
Mailing address:
  • Phone: 817-478-6041
  • Fax: 817-478-6041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06491
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number56720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: