Provider Demographics
NPI:1720086556
Name:NGUYEN, VINH QUY (MD)
Entity Type:Individual
Prefix:DR
First Name:VINH
Middle Name:QUY
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1593
Mailing Address - Country:US
Mailing Address - Phone:408-254-1794
Mailing Address - Fax:408-254-7284
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:SUITE 460
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-254-1794
Practice Address - Fax:408-254-7284
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG053256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G532560Medicaid
CA00G532560Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAE93229Medicare UPIN