Provider Demographics
NPI:1205883501
Name:NGUYEN, NGAI XUAN (MD)
Entity type:Individual
Prefix:
First Name:NGAI
Middle Name:XUAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 E SANTA CLARA ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1911
Mailing Address - Country:US
Mailing Address - Phone:408-971-8441
Mailing Address - Fax:408-295-6547
Practice Address - Street 1:696 E SANTA CLARA ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1911
Practice Address - Country:US
Practice Address - Phone:408-971-8441
Practice Address - Fax:408-295-6547
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA390570207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A28803Medicare UPIN