Provider Demographics
NPI:1811583362
Name:NGUYEN, VIVIAN HUYEN (PA-C)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:HUYEN
Last Name:NGUYEN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 N JACKSON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1909
Mailing Address - Country:US
Mailing Address - Phone:408-384-7160
Mailing Address - Fax:408-384-7161
Practice Address - Street 1:175 N JACKSON AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1909
Practice Address - Country:US
Practice Address - Phone:408-384-7160
Practice Address - Fax:408-384-7161
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA59227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant