MEDICARE: JOANN NGUYEN M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A122870	CA
2	207Q00000X	Family Medicine Physician	A122870	CA

General Provider Information

NPI Number	:	1205177854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN NGUYEN M.D

Provider Business Mailing Address
First Line	:	1255 E SANTA CLARA ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-2341
Country	:	US
Telephone Number	:	408-294-2868
Fax Number	:	408-294-2869

Provider Business Practice Location Address
First Line	:	1255 E SANTA CLARA ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-2341
Country	:	US
Telephone Number	:	408-294-2868
Fax Number	:	408-294-2869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2013
Last Update Date	:	10/20/2025

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