Provider Demographics
NPI:1821238254
Name:NGUYEN, CHANH CONG
Entity Type:Individual
Prefix:
First Name:CHANH
Middle Name:CONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 TULLY ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122
Mailing Address - Country:US
Mailing Address - Phone:408-937-1553
Mailing Address - Fax:408-937-1548
Practice Address - Street 1:2203 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1348
Practice Address - Country:US
Practice Address - Phone:408-937-1553
Practice Address - Fax:408-937-1548
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW226931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical