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General NPI Number Information
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NPI Number | 1447804851
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Entity Type | Individual
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Provider Name | JENNIFER THUY KHANH NGUYEN OD
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Gender | Female
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 15055 LOS GATOS BLVD STE 300
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City | LOS GATOS
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State | CA
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Zip | 95032-2056
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Country | US
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Telephone | 408-358-3932
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 BELLINGHAM DR
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City | SAN JOSE
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State | CA
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Zip | 95121-2315
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Country | US
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Telephone | 408-677-6451
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 34285
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License Number State | CA
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