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General NPI Number Information
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NPI Number | 1689125940
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Entity Type | Organization
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Legal Business Name | DR. HONGTRUC NGUYEN
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 345 ESTUDILLO AVE SUIT 101
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4702
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Country | US
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Telephone | 510-990-7989
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Fax |
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Provider Business Mailing Address
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Address Line | 345 ESTUDILLO AVE SUIT 101
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City | SAN LEANDRO
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State | CA
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Zip | 94577
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. HONGTRUC NGUYEN
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Credential | DC
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Telephone | 510-990-7989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 31881
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License Number State | CA
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