MEDICARE: DR. LINH PETER NGUYEN D.O.

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	20A7360	CA
2	261QP2300X	Primary Care Clinic/Center	20A7360	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	023997	OTHER	CA	VFC
2	20A7360	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1558353060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINH PETER NGUYEN D.O.

Provider Business Mailing Address
First Line	:	749 STORY RD
Second Line	:	SUITE 20
City	:	SAN JOSE
State	:	CA
Zip	:	95122-2600
Country	:	US
Telephone Number	:	408-794-2088
Fax Number	:	408-292-2179

Provider Business Practice Location Address
First Line	:	749 STORY RD
Second Line	:	SUITE 20
City	:	SAN JOSE
State	:	CA
Zip	:	95122-2600
Country	:	US
Telephone Number	:	408-794-2088
Fax Number	:	408-292-2179

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/11/2025

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