Provider Demographics
NPI:1063630770
Name:NGUYEN, VAN JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:JOHN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:11021 CATARINA LN UNIT 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-5691
Mailing Address - Country:US
Mailing Address - Phone:858-740-4455
Mailing Address - Fax:
Practice Address - Street 1:5348 CARROLL CANYON RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1753
Practice Address - Country:US
Practice Address - Phone:858-202-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY32365103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth