Provider Demographics
NPI:1053731273
Name:NGUYEN, PHI DINH (MD)
Entity type:Individual
Prefix:
First Name:PHI
Middle Name:DINH
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 1:1419 MONTEGO DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-5104
Mailing Address - Country:US
Mailing Address - Phone:408-677-8983
Mailing Address - Fax:
Practice Address - Street 1:1419 MONTEGO DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-5104
Practice Address - Country:US
Practice Address - Phone:408-677-8983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-27
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program