Provider Demographics
NPI:1912494873
Name:NGUYEN, THACH BAO JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:THACH BAO JONATHAN
Middle Name:
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 1:9508 STOCKDALE HWY STE 150
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3623
Mailing Address - Country:US
Mailing Address - Phone:661-663-7500
Mailing Address - Fax:661-663-7503
Practice Address - Street 1:9508 STOCKDALE HWY STE 150
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3623
Practice Address - Country:US
Practice Address - Phone:661-663-7500
Practice Address - Fax:661-663-7503
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA195490208000000X
WV30293208000000X
OH35.141244208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0446768Medicaid