Healthcare Provider Details

I. General information

NPI: 1154783645
Provider Name (Legal Business Name): MINHVU HOANG NGUYEN MD, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MINH-VU HOANG NGUYEN MD, MSC

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 100
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST STE 100
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-0848
  • Fax:
Mailing address:
  • Phone: 916-734-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberDR.0069031
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA152992
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: