Basic Information
| Provider Information | |||||||||
| NPI: | 1003141102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | KHOI | ||||||||
| MiddleName: | DUC | ||||||||
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| Credential: | MD, DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1295 FULBAR CT | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951323022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4084894832 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3800 JANES RD | ||||||||
| Address2: | |||||||||
| City: | ARCATA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955214742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4084894832 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2009 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A 11589 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.