Healthcare Provider Details

I. General information

NPI: 1568792927
Provider Name (Legal Business Name): TRINH T NGUYEN R.N., P.H.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 STORY RD
SAN JOSE CA
95127-3942
US

IV. Provider business mailing address

2676 ORINDA DR
SAN JOSE CA
95121-1231
US

V. Phone/Fax

Practice location:
  • Phone: 408-605-6158
  • Fax:
Mailing address:
  • Phone: 408-605-6158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20799
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number750645
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number75923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: