Provider Demographics
NPI:1306812896
Name:NGUYEN, MARK MINH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:751 S BASCOM AVE
Mailing Address - Street 2:SANTA CLARA VALLEY MEDICAL CENTER
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:408-885-2100
Mailing Address - Fax:408-885-2028
Practice Address - Street 1:751 S BASCOM AVE
Practice Address - Street 2:SANTA CLARA VALLEY MEDICAL CENTER
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-2100
Practice Address - Fax:408-885-2028
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA204530208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22602OtherBCBS MA
MA204530OtherTUFTS HEALTH PLAN
MA0157619Medicaid
H18731Medicare UPIN
MAA31221Medicare ID - Type Unspecified