Healthcare Provider Details

I. General information

NPI: 1972437242
Provider Name (Legal Business Name): ANDREW NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 INDUSTRIAL RD DEPT 190
SAN CARLOS CA
94070-2603
US

IV. Provider business mailing address

4742 MOUNTAIN BLVD
OAKLAND CA
94619-3012
US

V. Phone/Fax

Practice location:
  • Phone: 650-632-0816
  • Fax:
Mailing address:
  • Phone: 510-847-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: