Healthcare Provider Details

I. General information

NPI: 1255436515
Provider Name (Legal Business Name): TIM NGUYENTU D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6937 LINDA VISTA RD STE E
SAN DIEGO CA
92111-6366
US

IV. Provider business mailing address

6937 LINDA VISTA RD STE E
SAN DIEGO CA
92111-6366
US

V. Phone/Fax

Practice location:
  • Phone: 858-274-8888
  • Fax: 858-220-7526
Mailing address:
  • Phone: 858-274-8888
  • Fax: 858-220-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC 29987
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: