Healthcare Provider Details

I. General information

NPI: 1619480035
Provider Name (Legal Business Name): THIEN NGOC NGUYEN ND, DC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 TULLY RD # 232
SAN JOSE CA
95111-1013
US

IV. Provider business mailing address

9535 DUCHESS LN
STOCKTON CA
95209-1953
US

V. Phone/Fax

Practice location:
  • Phone: 408-605-9668
  • Fax:
Mailing address:
  • Phone: 408-605-9668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC35200
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60812081
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1058
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: