Provider Demographics
NPI:1154352185
Name:NGUYEN, THAO P (M D)
Entity type:Individual
Prefix:
First Name:THAO
Middle Name:P
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 ULRIC ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6040
Mailing Address - Country:US
Mailing Address - Phone:858-278-9393
Mailing Address - Fax:858-278-5393
Practice Address - Street 1:2406 ULRIC ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6040
Practice Address - Country:US
Practice Address - Phone:858-278-9393
Practice Address - Fax:858-278-5393
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81689207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G816890Medicaid
CA00G816890Medicaid