Healthcare Provider Details

I. General information

NPI: 1558353060
Provider Name (Legal Business Name): LINH PETER NGUYEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PETER LINH NGUYEN D.O.

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 STORY RD SUITE 20
SAN JOSE CA
95122-2600
US

IV. Provider business mailing address

749 STORY RD SUITE 20
SAN JOSE CA
95122-2600
US

V. Phone/Fax

Practice location:
  • Phone: 408-794-2088
  • Fax: 408-292-2179
Mailing address:
  • Phone: 408-794-2088
  • Fax: 408-292-2179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7360
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number20A7360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: