Provider Demographics
NPI:1609903400
Name:NGUYEN, CUONG THUC (MD)
Entity Type:Individual
Prefix:
First Name:CUONG
Middle Name:THUC
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 1:2400 MOORPARK AVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2631
Mailing Address - Country:US
Mailing Address - Phone:408-995-3474
Mailing Address - Fax:408-437-7523
Practice Address - Street 1:2400 MOORPARK AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2631
Practice Address - Country:US
Practice Address - Phone:408-995-3474
Practice Address - Fax:408-437-7523
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC512092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C512090Medicaid
CA00C512090Medicare PIN
A08543Medicare UPIN