MEDICARE: DR. CHAU THANH 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	207Q00000X	Family Medicine Physician	A34181	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285612028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAU THANH NGUYEN M.D.

Provider Business Mailing Address
First Line	:	200 JOSE FIGUERES AVE
Second Line	:	STE 325
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1592
Country	:	US
Telephone Number	:	408-259-0107
Fax Number	:	408-259-7508

Provider Business Practice Location Address
First Line	:	2116 MCKEE RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1427
Country	:	US
Telephone Number	:	408-259-0107
Fax Number	:	408-259-7508

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	10/11/2016

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