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NPI Code Detail

MEDICARE: MY THANH NGUYEN PA-C

MEDICARE: MY THANH NGUYEN PA-C
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
1363A00000XPhysician Assistant54470CA

General Provider Information

NPI Number : 1659809275
Entity Type Code : Individual
Provider Name (Legal Business Name) : MY THANH NGUYEN PA-C
Provider Business Mailing Address
First Line : 2616 GLEN COTSWOLD CT
Second Line :
City : SAN JOSE
State : CA
Zip : 95148-2544
Country : US
Telephone Number : 408-858-6458
Fax Number :
Provider Business Practice Location Address
First Line : 2331 MONTPELIER DR STE B
Second Line :
City : SAN JOSE
State : CA
Zip : 95116-1673
Country : US
Telephone Number : 408-347-9001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2017
Last Update Date : 03/17/2018

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Directions to “ MY THANH NGUYEN PA-C” Practice Location

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