Provider Demographics
NPI:1932425261
Name:NGUYEN, DAN-VINH PHAM (MD)
Entity Type:Individual
Prefix:
First Name:DAN-VINH
Middle Name:PHAM
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 1:4150 V ST
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-4597
Mailing Address - Fax:916-734-7924
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:SUITE 3400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-4597
Practice Address - Fax:916-734-7924
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932425261OtherUNITED HEALTHCARE
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCIGNA
VAPAROtherAETNA
VA1932425261OtherVIRGINIA PREMIER HEALTH PLAN
VA1932425261OtherCOVENTRY NETWORK
VA1932425261Medicaid
VA10112168OtherOPTIMA HEALTH
VA497840OtherANTHEM BC/BS
VAPAROtherMULTIPLAN
VA-028OtherTRICARE/CHAMPUS
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL
NC1932425261Medicaid
VAPAROtherCORVEL
NC1932425261Medicaid