Provider Demographics
NPI:1700926417
Name:NGUYEN, LAI DUC (DC)
Entity Type:Individual
Prefix:DR
First Name:LAI
Middle Name:DUC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 LEWIS RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-2196
Mailing Address - Country:US
Mailing Address - Phone:408-226-8877
Mailing Address - Fax:408-226-8845
Practice Address - Street 1:485 LEWIS RD STE C
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-2196
Practice Address - Country:US
Practice Address - Phone:408-226-8877
Practice Address - Fax:408-226-8845
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA680508583Medicare ID - Type UnspecifiedEIN
CADC0264540Medicare Oscar/Certification