Provider Demographics
NPI:1588612881
Name:NGUYEN, HIEP DUY (MD)
Entity Type:Individual
Prefix:DR
First Name:HIEP
Middle Name:DUY
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 1:1510 4TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1717
Mailing Address - Country:US
Mailing Address - Phone:510-525-8980
Mailing Address - Fax:510-525-8982
Practice Address - Street 1:1510 4TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1717
Practice Address - Country:US
Practice Address - Phone:510-525-8980
Practice Address - Fax:510-525-8982
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A735830Medicaid
00A735831Medicare PIN
CA00A735830Medicaid
H64018Medicare UPIN