Provider Demographics
NPI:1457559783
Name:NGUYEN, CAN (PHD)
Entity Type:Individual
Prefix:MR
First Name:CAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 GOLF CLUB RD # 206
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1524
Mailing Address - Country:US
Mailing Address - Phone:415-633-6828
Mailing Address - Fax:
Practice Address - Street 1:870 MARKET ST STE 1011
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2905
Practice Address - Country:US
Practice Address - Phone:415-633-6828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2023-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 251S00000X, 390200000X
CA103T00000X
CAPSY32525103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251S00000XAgenciesCommunity/Behavioral Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program