Provider Demographics
NPI:1952424004
Name:NGUYEN, STEPHANIE TRAM ANH (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TRAM ANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 STOCKTON BLVD.
Mailing Address - Street 2:U.C. DAVID MEDICAL CENTER
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-8118
Mailing Address - Fax:916-734-0629
Practice Address - Street 1:2516 STOCKTON BLVD.
Practice Address - Street 2:U.C. DAVID MEDICAL CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-8118
Practice Address - Fax:916-734-0629
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74187208000000X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH56165Medicare UPIN
H56165Medicare UPIN