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General NPI Number Information
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NPI Number | 1063682169
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Entity Type | Organization
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Legal Business Name | EUGENE V. NGUYEN, M.D., INC
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 1234 E NORTH ST STE 106
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City | MANTECA
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State | CA
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Zip | 95336-4960
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Country | US
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Telephone | 209-824-7600
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Fax | 209-824-9400
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Provider Business Mailing Address
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Address Line | PO BOX 690967
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City | STOCKTON
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State | CA
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Zip | 95269-0967
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Country | US
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Telephone | 209-824-7600
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Fax | 209-824-9400
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EUGENE VU NGUYEN
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Credential | M.D.
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Telephone | 209-824-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A94032
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License Number State | CA
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