Provider Demographics
NPI:1619206489
Name:NGUYEN, VAN-MINH (PA-C)
Entity type:Individual
Prefix:
First Name:VAN-MINH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-3120
Mailing Address - Country:US
Mailing Address - Phone:817-478-6041
Mailing Address - Fax:817-478-6041
Practice Address - Street 1:2020 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-3120
Practice Address - Country:US
Practice Address - Phone:916-341-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06491363A00000X
CA56720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB157889Medicare PIN
TXTXB157887Medicare PIN
TXTXB157886Medicare PIN