Provider Demographics
NPI:1609935113
Name:NGUYEN, NGOC (MD)
Entity Type:Individual
Prefix:DR
First Name:NGOC
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 MONTPELIER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1620
Mailing Address - Country:US
Mailing Address - Phone:408-272-3706
Mailing Address - Fax:408-254-4094
Practice Address - Street 1:2380 MONTPELIER DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1620
Practice Address - Country:US
Practice Address - Phone:408-272-3706
Practice Address - Fax:408-254-4094
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG070053207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G700530Medicaid
CAF65019Medicare UPIN
CA00G700530Medicare ID - Type Unspecified