Healthcare Provider Details

I. General information

NPI: 1386976769
Provider Name (Legal Business Name): TU NGUYEN MJAS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N 14TH ST STE 650
SAN JOSE CA
95112-6213
US

IV. Provider business mailing address

25 N 14TH ST STE 650
SAN JOSE CA
95112-6213
US

V. Phone/Fax

Practice location:
  • Phone: 585-208-4342
  • Fax: 408-297-2467
Mailing address:
  • Phone: 585-208-4342
  • Fax: 408-297-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA105350
License Number StateCA

VIII. Authorized Official

Name: TU V NGUYEN
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 585-208-4342