Provider Demographics
NPI:1699796227
Name:NGUYEN, JOSEPH M (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1104 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3875
Mailing Address - Country:US
Mailing Address - Phone:916-520-4466
Mailing Address - Fax:530-298-0326
Practice Address - Street 1:3340 TULLY RD
Practice Address - Street 2:SUITE C8A
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0838
Practice Address - Country:US
Practice Address - Phone:209-524-8700
Practice Address - Fax:209-524-8701
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT836YMedicaid
CAI00437Medicare UPIN
CAAT836YMedicaid