Provider Demographics
NPI:1437774049
Name:NGUYEN PHUC, BAO QUANG (DC)
Entity Type:Individual
Prefix:DR
First Name:BAO QUANG
Middle Name:
Last Name:NGUYEN PHUC
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3363 DA VINCI CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-4318
Mailing Address - Country:US
Mailing Address - Phone:408-421-0701
Mailing Address - Fax:
Practice Address - Street 1:536 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1212
Practice Address - Country:US
Practice Address - Phone:650-995-7243
Practice Address - Fax:650-995-7595
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor