Provider Demographics
NPI:1083778427
Name:NGUYEN, WILLIAM WHITMORE (MA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WHITMORE
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 JACKSON ST APT 104
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-4440
Mailing Address - Country:US
Mailing Address - Phone:707-554-2397
Mailing Address - Fax:
Practice Address - Street 1:408 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4453
Practice Address - Country:US
Practice Address - Phone:707-554-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3383Medicare ID - Type UnspecifiedMEDICAL-EPSDT