Provider Demographics
NPI:1194738849
Name:NGUYEN, SAN T (MD)
Entity type:Individual
Prefix:DR
First Name:SAN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4710
Mailing Address - Country:US
Mailing Address - Phone:626-282-6311
Mailing Address - Fax:626-282-6053
Practice Address - Street 1:1021 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4710
Practice Address - Country:US
Practice Address - Phone:626-282-6311
Practice Address - Fax:626-282-6053
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32179174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194738849Medicaid