Healthcare Provider Details

I. General information

NPI: 1588770762
Provider Name (Legal Business Name): HUY T.T. NGUYEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JOSE FIGUERES AVE SUITE 225
SAN JOSE CA
95116-1500
US

IV. Provider business mailing address

200 JOSE FIGUERES AVE SUITE 225
SAN JOSE CA
95116-1500
US

V. Phone/Fax

Practice location:
  • Phone: 408-929-5610
  • Fax: 408-929-5215
Mailing address:
  • Phone: 408-929-5610
  • Fax: 408-929-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A6987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: