Healthcare Provider Details

I. General information

NPI: 1164343125
Provider Name (Legal Business Name): JENNIFER MAI NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2284 ELLENA DR APT 3
SANTA CLARA CA
95050-6847
US

IV. Provider business mailing address

2284 ELLENA DR APT 3
SANTA CLARA CA
95050-6847
US

V. Phone/Fax

Practice location:
  • Phone: 408-669-6214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberASW139604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: