Provider Demographics
NPI:1821160573
Name:NGUYEN, PHILIPPE T (MD)
Entity Type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TRUNG
Other - Middle Name:THANH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1456 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4712
Mailing Address - Country:US
Mailing Address - Phone:415-409-3456
Mailing Address - Fax:415-500-2417
Practice Address - Street 1:1456 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4712
Practice Address - Country:US
Practice Address - Phone:415-409-3456
Practice Address - Fax:415-500-2417
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51974208M00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C519740Medicaid
CA00C519740OtherBCBS OF CA
CA00C519740OtherBCBS OF CA
I05106Medicare UPIN
00C519740Medicare ID - Type Unspecified