Provider Demographics
NPI:1013476878
Name:NGUYEN, QUOC-HAN
Entity type:Individual
Prefix:
First Name:QUOC-HAN
Middle Name:
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 1:1524 MCHENRY AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4567
Mailing Address - Country:US
Mailing Address - Phone:209-577-4444
Mailing Address - Fax:813-916-2944
Practice Address - Street 1:1524 MCHENRY AVE STE 420
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4567
Practice Address - Country:US
Practice Address - Phone:209-577-4444
Practice Address - Fax:209-852-2287
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1946962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program