Healthcare Provider Details

I. General information

NPI: 1992240634
Provider Name (Legal Business Name): TUANJAY A. NGUYEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 PINE ST
SAN FRANCISCO CA
94104-2803
US

IV. Provider business mailing address

483 PINE ST
SAN FRANCISCO CA
94104-2803
US

V. Phone/Fax

Practice location:
  • Phone: 415-872-9376
  • Fax:
Mailing address:
  • Phone: 415-298-4387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number35509
License Number StateCA

VIII. Authorized Official

Name: TUANJAY A NGUYEN
Title or Position: OWNER
Credential: PT
Phone: 415-298-4387