Provider Demographics
NPI:1639617723
Name:NUYEN, JADE BAO-TRAN
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:BAO-TRAN
Last Name:NUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:BAO-TRAN
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:514 WHITESAGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-7920
Mailing Address - Country:US
Mailing Address - Phone:760-805-1175
Mailing Address - Fax:
Practice Address - Street 1:1901 CARNEGIE AVE STE 1C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5504
Practice Address - Country:US
Practice Address - Phone:714-848-8319
Practice Address - Fax:714-596-6274
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other