Healthcare Provider Details

I. General information

NPI: 1538393608
Provider Name (Legal Business Name): ANTHONY SCOTT NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY NGUYEN

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUSH ST STE 420
SAN FRANCISCO CA
94104-3907
US

IV. Provider business mailing address

1330 28TH AVE
SAN FRANCISCO CA
94122-1513
US

V. Phone/Fax

Practice location:
  • Phone: 415-956-2884
  • Fax: 415-956-2662
Mailing address:
  • Phone: 415-513-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: