Provider Demographics
NPI:1194803965
Name:NGUYEN, MYNGOC THI (MD)
Entity type:Individual
Prefix:DR
First Name:MYNGOC
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MYNGOC
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:275 W MACARTHUR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5641
Mailing Address - Country:US
Mailing Address - Phone:510-752-1000
Mailing Address - Fax:
Practice Address - Street 1:3010 COLBY ST STE 118
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2059
Practice Address - Country:US
Practice Address - Phone:510-644-2316
Practice Address - Fax:510-704-8346
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50040207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G500400Medicaid
CA00G500400Medicaid
00G500400Medicare ID - Type Unspecified