Provider Demographics
NPI:1821032475
Name:NGUYEN, BAO Q (MD)
Entity Type:Individual
Prefix:DR
First Name:BAO
Middle Name:Q
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:Q
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7304
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0304
Mailing Address - Country:US
Mailing Address - Phone:209-475-8144
Mailing Address - Fax:
Practice Address - Street 1:2333 W MARCH LN
Practice Address - Street 2:# A2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5263
Practice Address - Country:US
Practice Address - Phone:209-475-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92725207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A927250Medicaid
CA00A927250Medicare PIN
CAI50050Medicare UPIN
CAP00335316Medicare PIN
CA00A927250Medicaid
CABN210YMedicare PIN