Provider Demographics
NPI:1871686568
Name:NGUYEN, LINH P (DC)
Entity Type:Individual
Prefix:
First Name:LINH
Middle Name:P
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15817 CHANNEL STREET
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580
Mailing Address - Country:US
Mailing Address - Phone:510-278-0279
Mailing Address - Fax:510-278-0379
Practice Address - Street 1:15817 CHANNEL STREET
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580
Practice Address - Country:US
Practice Address - Phone:510-278-0279
Practice Address - Fax:510-278-0379
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0249110Medicare ID - Type Unspecified