Provider Demographics
NPI:1285121723
Name:MAI-ANH CHTN NGUYEN, O.D., INC
Entity type:Organization
Organization Name:MAI-ANH CHTN NGUYEN, O.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAI-ANH
Authorized Official - Middle Name:CHTN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-238-4558
Mailing Address - Street 1:1661 BURDETTE DR STE H
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1681
Mailing Address - Country:US
Mailing Address - Phone:408-238-4558
Mailing Address - Fax:406-238-4576
Practice Address - Street 1:1661 BURDETTE DR STE H
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1681
Practice Address - Country:US
Practice Address - Phone:408-238-4558
Practice Address - Fax:406-238-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11482T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0114820Medicaid