Provider Demographics
NPI:1427055631
Name:NGUYEN, HAI V (MD)
Entity type:Individual
Prefix:DR
First Name:HAI
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2543
Mailing Address - Country:US
Mailing Address - Phone:510-205-4688
Mailing Address - Fax:510-832-1707
Practice Address - Street 1:711 E 12TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-3624
Practice Address - Country:US
Practice Address - Phone:510-832-1905
Practice Address - Fax:510-832-1707
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A441451Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
A29763Medicare UPIN