Healthcare Provider Details

I. General information

NPI: 1558531962
Provider Name (Legal Business Name): TUNG T. NGUYEN, D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 TULLY RD SUITE A 105
SAN JOSE CA
95111-1013
US

IV. Provider business mailing address

621 TULLY RD SUITE A 105
SAN JOSE CA
95111-1013
US

V. Phone/Fax

Practice location:
  • Phone: 408-279-2988
  • Fax:
Mailing address:
  • Phone: 408-279-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number20A8238
License Number StateCA

VIII. Authorized Official

Name: TUNG THANH NGUYEN
Title or Position: OWNER/PRESIDENT
Credential: D.O.
Phone: 408-279-2988