Healthcare Provider Details

I. General information

NPI: 1487399085
Provider Name (Legal Business Name): RANDY THANH NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE BLDG. 25, 1ST FLOOR
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1001 POTRERO AVENUE BLDG. 25, FIRST FLOOR
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8111
  • Fax:
Mailing address:
  • Phone: 628-206-8111
  • Fax: 628-206-9038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA209779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: