Provider Demographics
NPI:1649228222
Name:LAN TUYET NGUYEN, M.D., INC.
Entity Type:Organization
Organization Name:LAN TUYET NGUYEN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-298-4145
Mailing Address - Street 1:135 N JACKSON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1917
Mailing Address - Country:US
Mailing Address - Phone:408-923-4145
Mailing Address - Fax:408-923-4156
Practice Address - Street 1:135 N JACKSON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1917
Practice Address - Country:US
Practice Address - Phone:408-923-4145
Practice Address - Fax:408-923-4156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71625174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A716250Medicaid
CA00A716250Medicaid
CA=========OtherOTHER HEALTHCARE: PPO ...
CAZZZ28620ZMedicare ID - Type Unspecified