=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518396712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NGAI NGUYEN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2013
-----------------------------------------------------
Last Update Date | 11/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 696 E SANTA CLARA ST 108
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95112-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-971-8441
-----------------------------------------------------
Fax | 408-295-6547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 696 E SANTA CLARA ST 108
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95112-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NGAI NGUYEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 408-971-8441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | A39057
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------