Provider Demographics
NPI:1174516264
Name:NGUYEN, LAN TUYET (MD)
Entity type:Individual
Prefix:DR
First Name:LAN
Middle Name:TUYET
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N JACKSON AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1917
Mailing Address - Country:US
Mailing Address - Phone:408-923-4145
Mailing Address - Fax:408-923-4156
Practice Address - Street 1:135 N JACKSON AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-923-4145
Practice Address - Fax:408-923-4156
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2018-07-26
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
CAA716250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A716250Medicaid
CA00A716250Medicaid
CAA71625Medicare UPIN