Provider Demographics
NPI:1063682169
Name:EUGENE V. NGUYEN, M.D., INC
Entity type:Organization
Organization Name:EUGENE V. NGUYEN, M.D., INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:VU
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-824-7600
Mailing Address - Street 1:PO BOX 690967
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95269-0967
Mailing Address - Country:US
Mailing Address - Phone:209-824-7600
Mailing Address - Fax:209-824-9400
Practice Address - Street 1:1234 E NORTH ST
Practice Address - Street 2:STE 106
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4960
Practice Address - Country:US
Practice Address - Phone:209-824-7600
Practice Address - Fax:209-824-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty