Healthcare Provider Details

I. General information

NPI: 1700838315
Provider Name (Legal Business Name): VAN HONG THI NGUYEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 Q ST
SACRAMENTO CA
95816-7058
US

IV. Provider business mailing address

PO BOX 690854
STOCKTON CA
95269
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-3400
  • Fax: 916-733-5940
Mailing address:
  • Phone: 209-954-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA18060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: