Provider Demographics
NPI:1285612028
Name:NGUYEN, CHAU THANH (MD)
Entity type:Individual
Prefix:DR
First Name:CHAU
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:STE 325
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1592
Mailing Address - Country:US
Mailing Address - Phone:408-259-0107
Mailing Address - Fax:408-259-7508
Practice Address - Street 1:2116 MCKEE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1427
Practice Address - Country:US
Practice Address - Phone:408-259-0107
Practice Address - Fax:408-259-7508
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA34181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341810Medicaid
CA00A341810Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CA00A341810Medicaid