Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 11153 | CA |
NPI | 1003318270 |
---|---|
Provider Name | Henry Ngoc Nguyen |
First Address | Oakland, CA 94606-4942 |
Second Address | Oakland, CA 94611-2809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2018 |
Last Update Date | 03/01/2022 |