Provider Demographics
NPI:1033394663
Name:NGUYEN, SANG THI (DO)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1258
Mailing Address - Country:US
Mailing Address - Phone:480-280-5024
Mailing Address - Fax:
Practice Address - Street 1:1535 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1258
Practice Address - Country:US
Practice Address - Phone:480-280-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR1067OtherTRAINING PERMIT
CA20A11006OtherOSTEOPATHIC MEDICAL BOARD OF CALIFORNIA