Provider Demographics
NPI:1114119526
Name:NGUYEN, SON LAM (MD)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:LAM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5184 PALACE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-4161
Mailing Address - Country:US
Mailing Address - Phone:707-863-7485
Mailing Address - Fax:
Practice Address - Street 1:1525 WEBSTER ST
Practice Address - Street 2:A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4997
Practice Address - Country:US
Practice Address - Phone:707-423-9484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100779207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine