Provider Demographics
NPI:1518982057
Name:NGUYEN, KHOA D (MD)
Entity Type:Individual
Prefix:DR
First Name:KHOA
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 FOREST AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1422
Mailing Address - Country:US
Mailing Address - Phone:408-993-8071
Mailing Address - Fax:408-993-8609
Practice Address - Street 1:2100 FOREST AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1422
Practice Address - Country:US
Practice Address - Phone:408-993-8071
Practice Address - Fax:408-993-8609
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A500840207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A500840Medicaid
CAG31440Medicare UPIN
CA00A500840Medicaid