Provider Demographics
NPI:1558531962
Name:TUNG T. NGUYEN, D.O., INC.
Entity Type:Organization
Organization Name:TUNG T. NGUYEN, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TUNG
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:408-279-2988
Mailing Address - Street 1:621 TULLY RD
Mailing Address - Street 2:SUITE A 105
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1013
Mailing Address - Country:US
Mailing Address - Phone:408-279-2988
Mailing Address - Fax:
Practice Address - Street 1:621 TULLY RD
Practice Address - Street 2:SUITE A 105
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1013
Practice Address - Country:US
Practice Address - Phone:408-279-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8238261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH67112Medicare UPIN