Healthcare Provider Details

I. General information

NPI: 1598791352
Provider Name (Legal Business Name): QUYNH QUEEN A NGUYEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 BURDETTE DR STE 20
SAN JOSE CA
95121-1667
US

IV. Provider business mailing address

1675 BURDETTE DR STE 20
SAN JOSE CA
95121-1667
US

V. Phone/Fax

Practice location:
  • Phone: 408-274-6944
  • Fax: 408-274-2258
Mailing address:
  • Phone: 408-274-6944
  • Fax: 408-274-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8237
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A8237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: