Provider Demographics
NPI:1447804851
Name:NGUYEN, JENNIFER THUY KHANH (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:THUY KHANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 BELLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-2315
Mailing Address - Country:US
Mailing Address - Phone:408-677-6451
Mailing Address - Fax:
Practice Address - Street 1:15055 LOS GATOS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2056
Practice Address - Country:US
Practice Address - Phone:408-358-3932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34285152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist