Provider Demographics
NPI:1750724365
Name:NGUYEN, THU NGOC DIEM (DC)
Entity type:Individual
Prefix:DR
First Name:THU
Middle Name:NGOC DIEM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:THU
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:2858 STEVENS CREEK BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4607
Mailing Address - Country:US
Mailing Address - Phone:408-502-9761
Mailing Address - Fax:408-502-9758
Practice Address - Street 1:2858 STEVENS CREEK BLVD STE 208
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4607
Practice Address - Country:US
Practice Address - Phone:408-502-9761
Practice Address - Fax:408-502-9758
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13232014100066OtherCNN
CA5301458522OtherDOT MEDICAL EXAMINER