Provider Demographics
NPI:1558353060
Name:NGUYEN, LINH PETER (DO)
Entity Type:Individual
Prefix:DR
First Name:LINH
Middle Name:PETER
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:LINH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:749 STORY RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2600
Mailing Address - Country:US
Mailing Address - Phone:408-794-2088
Mailing Address - Fax:408-292-2179
Practice Address - Street 1:749 STORY RD
Practice Address - Street 2:SUITE 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2600
Practice Address - Country:US
Practice Address - Phone:408-794-2088
Practice Address - Fax:408-292-2179
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7360207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA023997OtherVFC
CA20A7360OtherMEDICAL LICENSE
CAH27272Medicare UPIN
CA20A7360OtherMEDICAL LICENSE