Provider Demographics
NPI:1841474806
Name:NGUYEN, KATHY MY (DC)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:MY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MYDUNG
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:940 STORY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2629
Mailing Address - Country:US
Mailing Address - Phone:408-998-0808
Mailing Address - Fax:408-998-0829
Practice Address - Street 1:940 STORY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2629
Practice Address - Country:US
Practice Address - Phone:408-998-0808
Practice Address - Fax:408-998-0829
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30725111N00000X
CADC30725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30725OtherLICENSE NO
CACA120646Medicare PIN