Provider Demographics
NPI:1154349348
Name:NGUYEN, MATTHEW VAN (DC)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MATTHEW
Other - Middle Name:VAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:L AC , CMTPT
Mailing Address - Street 1:755 OFARRELL ST
Mailing Address - Street 2:# 23
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7163
Mailing Address - Country:US
Mailing Address - Phone:415-370-2577
Mailing Address - Fax:
Practice Address - Street 1:870 MARKET ST
Practice Address - Street 2:SUITE 883
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3099
Practice Address - Country:US
Practice Address - Phone:415-362-6274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27499111N00000X
CA9334171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2456005Medicare PIN