Provider Demographics
NPI:1962054213
Name:NGUYEN, PHUONG THI DU (PA-C)
Entity type:Individual
Prefix:
First Name:PHUONG THI DU
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39465 PASEO PADRE PKWY STE 2600
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1631
Mailing Address - Country:US
Mailing Address - Phone:510-456-2390
Mailing Address - Fax:
Practice Address - Street 1:39465 PASEO PADRE PKWY STE 2600
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1631
Practice Address - Country:US
Practice Address - Phone:510-456-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58688363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant