Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G50040 | CA |
NPI | 1194803965 |
---|---|
Provider Name | Dr. Myngoc Thi Nguyen |
First Address | Oakland, CA 94611-5641 |
Second Address | Piedmont, CA 94611-3540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 31/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G500400 | (05) | CA |
F12897 | (02) |