Provider Demographics
NPI:1457460354
Name:NGUYEN, MINHTAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:MINHTAM
Middle Name:S
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MINHTAM
Other - Middle Name:S
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1340 TULLY ROAD, SUITE 309
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3057
Mailing Address - Country:US
Mailing Address - Phone:408-993-8536
Mailing Address - Fax:408-993-8539
Practice Address - Street 1:1340 TULLY RD STE 309
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3055
Practice Address - Country:US
Practice Address - Phone:408-993-8536
Practice Address - Fax:408-993-8539
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABZ777AOtherMEDICARE PTAN
CA00A454790Medicaid
CA00A454790Medicaid
CA00A454790Medicaid