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General NPI Number Information
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NPI Number | 1285121723
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Entity Type | Organization
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Legal Business Name | MAI-ANH CHTN NGUYEN, O.D., INC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1661 BURDETTE DR STE H
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City | SAN JOSE
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State | CA
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Zip | 95121-1681
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Country | US
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Telephone | 408-238-4558
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Fax | 406-238-4576
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Provider Business Mailing Address
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Address Line | 1661 BURDETTE DR STE H
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City | SAN JOSE
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State | CA
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Zip | 95121-1681
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Country | US
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Telephone | 408-238-4558
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Fax | 406-238-4576
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | DR. MAI-ANH CHTN NGUYEN
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Credential | OD
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Telephone | 408-238-4558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11482T
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License Number State | CA
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