Provider Demographics
NPI:1972989853
Name:NGUYEN, DI
Entity type:Individual
Prefix:
First Name:DI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N SAN PEDRO RD
Mailing Address - Street 2:SUITE 2021
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4188
Mailing Address - Country:US
Mailing Address - Phone:415-473-2959
Mailing Address - Fax:415-473-2959
Practice Address - Street 1:20 N SAN PEDRO RD
Practice Address - Street 2:SUITE 2021
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4188
Practice Address - Country:US
Practice Address - Phone:415-473-2959
Practice Address - Fax:415-473-2959
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program