Healthcare Provider Details

I. General information

NPI: 1538225156
Provider Name (Legal Business Name): LIEN HUYEN THI NGUYEN, MD., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 W MARCH LN STE. C
STOCKTON CA
95207-5726
US

IV. Provider business mailing address

73 W MARCH LN STE. C
STOCKTON CA
95207-5726
US

V. Phone/Fax

Practice location:
  • Phone: 209-957-3901
  • Fax: 209-957-2857
Mailing address:
  • Phone: 209-957-3901
  • Fax: 209-957-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00A373770
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00A373770
License Number StateCA

VIII. Authorized Official

Name: LEU VANG
Title or Position: MANAGER
Credential:
Phone: 209-957-3901