Healthcare Provider Details

I. General information

NPI: 1063267292
Provider Name (Legal Business Name): ANDREW NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 PARNASSUS AVE
SAN FRANCISCO CA
94143-2210
US

IV. Provider business mailing address

165 JOHNSTONE DR APT 306
SAN FRANCISCO CA
94131-1193
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-5800
  • Fax:
Mailing address:
  • Phone: 714-782-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: