Provider Demographics
NPI:1962550491
Name:NGHIEM, JUSTINE (MD)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:NGHIEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:820 PARK ROW PMB 470
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2406
Mailing Address - Country:US
Mailing Address - Phone:831-435-9200
Mailing Address - Fax:831-757-4070
Practice Address - Street 1:315 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-5736
Practice Address - Country:US
Practice Address - Phone:831-424-1878
Practice Address - Fax:831-424-3149
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG87687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00653842OtherRAILROAD MEDICARE
CAC030OtherTRICARE
CAP00653842OtherRAILROAD MEDICARE