Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A 11589 | CA |
NPI | 1003141102 |
---|---|
Provider Name | Khoi Duc Nguyen |
First Address | San Jose, CA 95132-3022 |
Second Address | Arcata, CA 95521-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2009 |
Last Update Date | 14/02/2013 |