Healthcare Provider Details

I. General information

NPI: 1558280065
Provider Name (Legal Business Name): TOMMY VAN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 MISSION ST
SAN FRANCISCO CA
94103-1519
US

IV. Provider business mailing address

157 WOODRIDGE DR
VALLEJO CA
94591-4147
US

V. Phone/Fax

Practice location:
  • Phone: 510-931-8876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: