Healthcare Provider Details

I. General information

NPI: 1215737762
Provider Name (Legal Business Name): DIANE NGUYEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N JACKSON AVE STE 235
SAN JOSE CA
95116-1635
US

IV. Provider business mailing address

227 N JACKSON AVE STE 235
SAN JOSE CA
95116-1635
US

V. Phone/Fax

Practice location:
  • Phone: 408-440-6705
  • Fax:
Mailing address:
  • Phone: 408-254-9192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: