Provider Demographics
NPI:1407876659
Name:DO, CHISTOPHER NGUYEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHISTOPHER
Middle Name:NGUYEN
Last Name:DO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1569 LEXANN AVENUE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121
Mailing Address - Country:US
Mailing Address - Phone:408-531-8808
Mailing Address - Fax:408-531-8940
Practice Address - Street 1:1569 LEXANN AVENUE
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121
Practice Address - Country:US
Practice Address - Phone:408-531-8808
Practice Address - Fax:408-531-8940
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA00A628770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0934276OtherCLIA NUMBER
CA00A628770Medicaid
CA1043343650OtherCORPORATE NPI
CA05D0934276OtherCLIA NUMBER
CA00A628770Medicare ID - Type Unspecified
CA27-0041442OtherTAX ID NUMBER