Provider Demographics
NPI:1225063290
Name:NGUYEN, VU HOANG (DO)
Entity Type:Individual
Prefix:
First Name:VU
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N JACKSON AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1621
Mailing Address - Country:US
Mailing Address - Phone:408-251-6127
Mailing Address - Fax:
Practice Address - Street 1:210 N JACKSON AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1621
Practice Address - Country:US
Practice Address - Phone:408-251-6127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine