Provider Demographics
NPI:1437897758
Name:NGUYEN, PHILLIP SON (RN)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:SON
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4234 KINGSPARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-2318
Mailing Address - Country:US
Mailing Address - Phone:408-313-2509
Mailing Address - Fax:
Practice Address - Street 1:4234 KINGSPARK DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-2318
Practice Address - Country:US
Practice Address - Phone:408-313-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95274166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse