Provider Demographics
NPI:1528745148
Name:JULLIAN NGUYEN MD SPORTS & FAMILY MEDICINE
Entity type:Organization
Organization Name:JULLIAN NGUYEN MD SPORTS & FAMILY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JULLIAN
Authorized Official - Middle Name:PHAM
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-726-4501
Mailing Address - Street 1:2301 LILAC ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-6552
Mailing Address - Country:US
Mailing Address - Phone:408-726-4501
Mailing Address - Fax:
Practice Address - Street 1:930 SUNNYSLOPE RD STE E1
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5638
Practice Address - Country:US
Practice Address - Phone:408-726-4501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-05
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care