Provider Demographics
NPI:1962623462
Name:NGUYEN, LOC TAN (MD)
Entity type:Individual
Prefix:
First Name:LOC
Middle Name:TAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4545 GEORGETOWN PL STE C16
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6230
Mailing Address - Country:US
Mailing Address - Phone:209-227-9297
Mailing Address - Fax:209-297-4594
Practice Address - Street 1:4545 GEORGETOWN PL STE C16
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6230
Practice Address - Country:US
Practice Address - Phone:209-227-9297
Practice Address - Fax:209-297-4594
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2021-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA133981207R00000X
CA133981207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine