Provider Demographics
NPI:1932835956
Name:VAN, NINA HUE (OD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:HUE
Last Name:VAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:250 BALDWIN AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3900
Mailing Address - Country:US
Mailing Address - Phone:562-912-9264
Mailing Address - Fax:
Practice Address - Street 1:1183 S DE ANZA BLVD STE 50
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3659
Practice Address - Country:US
Practice Address - Phone:408-366-1681
Practice Address - Fax:408-366-1680
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX10564152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35409TLGOtherLICENSE
TX10564OtherLICENSE