Provider Demographics
NPI:1265581623
Name:NGUYEN, HELENA HP (OD)
Entity type:Individual
Prefix:DR
First Name:HELENA
Middle Name:HP
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-2809
Mailing Address - Country:US
Mailing Address - Phone:408-247-5102
Mailing Address - Fax:408-247-5946
Practice Address - Street 1:3480 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-2809
Practice Address - Country:US
Practice Address - Phone:408-247-5102
Practice Address - Fax:408-247-5946
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10036T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0100360Medicaid
CASD0100360Medicaid
CAP00283855Medicare PIN