Provider Demographics
NPI:1194033183
Name:NGUYEN, JENNIFER HO (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HO
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 S KROEGER ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4763
Mailing Address - Country:US
Mailing Address - Phone:909-319-8314
Mailing Address - Fax:
Practice Address - Street 1:16803 VALLEY BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-9242
Practice Address - Country:US
Practice Address - Phone:909-349-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13983152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist