Provider Demographics
NPI:1073614350
Name:NGUYEN, JOANNA HOANG (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 CREEKSIDE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3831
Mailing Address - Country:US
Mailing Address - Phone:916-983-3069
Mailing Address - Fax:916-983-4569
Practice Address - Street 1:1641 CREEKSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3831
Practice Address - Country:US
Practice Address - Phone:916-983-3069
Practice Address - Fax:916-983-4569
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI61570Medicare UPIN
00A923420Medicare PIN