Provider Demographics
NPI:1033792759
Name:NGUYEN, JENNY THUY TIEN (MD, MA)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:THUY TIEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 SLOAT BLVD STE 333
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1255
Mailing Address - Country:US
Mailing Address - Phone:415-353-9339
Mailing Address - Fax:415-353-3450
Practice Address - Street 1:1569 SLOAT BLVD STE 333
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1255
Practice Address - Country:US
Practice Address - Phone:415-353-9339
Practice Address - Fax:415-353-3450
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA192399207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program