Provider Demographics
NPI:1598791352
Name:NGUYEN, QUYNH QUEEN A (DO)
Entity Type:Individual
Prefix:
First Name:QUYNH QUEEN
Middle Name:A
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 BURDETTE DR STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1667
Mailing Address - Country:US
Mailing Address - Phone:408-274-6944
Mailing Address - Fax:408-274-2258
Practice Address - Street 1:1675 BURDETTE DR STE 20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1667
Practice Address - Country:US
Practice Address - Phone:408-274-6944
Practice Address - Fax:408-274-2258
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8237207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX82370Medicaid
CAH93930Medicare UPIN