Healthcare Provider Details

I. General information

NPI: 1285136168
Provider Name (Legal Business Name): RYAN TUAN-KHANH NGUYEN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RYAN TUANKHANH NGUYEN AMFT

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W JULIAN ST
SAN JOSE CA
95126-2719
US

IV. Provider business mailing address

781 ANACAPA CT
MILPITAS CA
95035-4548
US

V. Phone/Fax

Practice location:
  • Phone: 408-292-9353
  • Fax: 408-287-3104
Mailing address:
  • Phone: 408-398-6638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120290
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145670
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: