Provider Demographics
NPI:1689771156
Name:NGUYEN, LINH NGOC (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINH
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 S BASCOM AVE
Mailing Address - Street 2:SCVMC/REHAB/THERAPY SERVICES
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:510-396-6166
Mailing Address - Fax:510-740-0583
Practice Address - Street 1:39675 CEDAR BLVD STE 240A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-8540
Practice Address - Country:US
Practice Address - Phone:510-396-6166
Practice Address - Fax:510-740-0583
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical