Provider Demographics
NPI:1730261231
Name:NGUYEN, KHANH QUOC (DC)
Entity type:Individual
Prefix:DR
First Name:KHANH
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 TULLY RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3056
Mailing Address - Country:US
Mailing Address - Phone:408-298-4560
Mailing Address - Fax:408-516-5262
Practice Address - Street 1:1370 TULLY RD
Practice Address - Street 2:SUITE 508
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3056
Practice Address - Country:US
Practice Address - Phone:408-298-4560
Practice Address - Fax:408-516-5262
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0199310Medicaid
CADC0199310Medicaid