Healthcare Provider Details

I. General information

NPI: 1639096233
Provider Name (Legal Business Name): ANDREW PHUOC-HUNG NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 HAMILTON AVE
SAN JOSE CA
95125-4540
US

IV. Provider business mailing address

3052 POSTWOOD DR
SAN JOSE CA
95132-1136
US

V. Phone/Fax

Practice location:
  • Phone: 800-913-2615
  • Fax:
Mailing address:
  • Phone: 408-828-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE0281494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: