Provider Demographics
NPI:1861587446
Name:NGUYEN, TAO VAN (MD)
Entity type:Individual
Prefix:
First Name:TAO
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 BURDETTE DR STE B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1681
Mailing Address - Country:US
Mailing Address - Phone:408-238-4542
Mailing Address - Fax:408-238-4542
Practice Address - Street 1:1661 BURDETTE DR STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121
Practice Address - Country:US
Practice Address - Phone:408-238-4542
Practice Address - Fax:408-238-4542
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA454072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A454070Medicaid
CA00A454071Medicare ID - Type Unspecified
CAD65055Medicare UPIN