Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 59672 | CA |
NPI | 1003122375 |
---|---|
Provider Name | Dr. Anh T Nguyen |
First Address | San Francisco, CA 94115-2860 |
Second Address | San Francisco, CA 94115-2860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2010 |
Last Update Date | 25/08/2010 |