Healthcare Provider Details

I. General information

NPI: 1144775198
Provider Name (Legal Business Name): HOANG M NGUYEN DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N JACKSON AVE STE 210
SAN JOSE CA
95116-1909
US

IV. Provider business mailing address

175 N JACKSON AVE STE 210
SAN JOSE CA
95116-1909
US

V. Phone/Fax

Practice location:
  • Phone: 408-708-7053
  • Fax: 408-708-7189
Mailing address:
  • Phone: 408-708-7053
  • Fax: 408-708-7189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number20A10655
License Number StateCA

VIII. Authorized Official

Name: HOANG M NGUYEN
Title or Position: OWNER
Credential: D.O.
Phone: 408-418-1582