Provider Demographics
NPI:1457599789
Name:NGUYEN, PHUONG TUY (MD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:TUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4585 STEVENS CREEK BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6769
Mailing Address - Country:US
Mailing Address - Phone:408-296-2496
Mailing Address - Fax:408-520-4575
Practice Address - Street 1:4585 STEVENS CREEK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-6769
Practice Address - Country:US
Practice Address - Phone:408-296-2496
Practice Address - Fax:408-520-4575
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106053207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology