Provider Demographics
NPI:1548206113
Name:NGUYEN, DAN-ANH THI (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN-ANH
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
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:STE 105
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-993-8071
Mailing Address - Fax:
Practice Address - Street 1:2100 FOREST AVE
Practice Address - Street 2:STE 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:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G669680207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G669680Medicaid
CAE47739Medicare UPIN
CA00G669680Medicare PIN