Healthcare Provider Details

I. General information

NPI: 1205177854
Provider Name (Legal Business Name): JOANN NGUYEN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 E SANTA CLARA ST
SAN JOSE CA
95116-2341
US

IV. Provider business mailing address

1255 E SANTA CLARA ST
SAN JOSE CA
95116-2341
US

V. Phone/Fax

Practice location:
  • Phone: 408-294-2868
  • Fax: 408-294-2869
Mailing address:
  • Phone: 408-294-2868
  • Fax: 408-294-2869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA122870
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA122870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: