Provider Demographics
NPI:1568281665
Name:NGUYEN, DIANA NGOC DAN
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:NGOC DAN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 RAMSTREE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1939
Mailing Address - Country:US
Mailing Address - Phone:408-636-8436
Mailing Address - Fax:
Practice Address - Street 1:1405 FOXWORTHY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1119
Practice Address - Country:US
Practice Address - Phone:408-264-0371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist