Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | EL7021 | CA |
NPI | 1255909958 |
---|---|
Provider Name | Christopher Nguyen |
First Address | Petaluma, CA 94954-3559 |
Second Address | Vallejo, CA 94589-2441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2021 |
Last Update Date | 17/06/2021 |