Provider Demographics
NPI:1134501034
Name:NGUYEN PHAN, ANH TUAN
Entity Type:Individual
Prefix:MR
First Name:ANH TUAN
Middle Name:
Last Name:NGUYEN PHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 MARIAN LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-2023
Mailing Address - Country:US
Mailing Address - Phone:408-724-7877
Mailing Address - Fax:
Practice Address - Street 1:160 E VIRGINIA ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5865
Practice Address - Country:US
Practice Address - Phone:408-918-2618
Practice Address - Fax:408-579-6143
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health