Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A74187 | CA |
Y | 2080P0210X | Pediatric Nephrologist | A74187 | CA |
NPI | 1952424004 |
---|---|
Provider Name | Stephanie Tram Anh Nguyen |
First Address | Sacramento, CA 95817 |
Second Address | Sacramento, CA 95817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 10/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H56165 | (02) | |
H56165 | (02) | CA |