Provider Demographics
NPI:1427263516
Name:NGUYEN, EUGENE V (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2333 W MARCH LN
Mailing Address - Street 2:STE A2
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5263
Mailing Address - Country:US
Mailing Address - Phone:209-824-7600
Mailing Address - Fax:209-824-9400
Practice Address - Street 1:1234 E NORTH ST
Practice Address - Street 2:STE 106
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4960
Practice Address - Country:US
Practice Address - Phone:209-824-7600
Practice Address - Fax:209-824-9400
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA94032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A940321Medicare PIN
CA285ZMedicare PIN