Provider Demographics
NPI:1164939930
Name:NGUYEN, EDWARD ANDY (PA-C, MHS)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ANDY
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA-C, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 JASMINE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-2377
Mailing Address - Country:US
Mailing Address - Phone:408-506-4943
Mailing Address - Fax:
Practice Address - Street 1:750 WELCH RD STE 319
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1510
Practice Address - Country:US
Practice Address - Phone:650-498-5689
Practice Address - Fax:650-498-5690
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55069363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical