Provider Demographics
NPI:1447996293
Name:NGUYEN, JOHNSON PHONG
Entity type:Individual
Prefix:
First Name:JOHNSON
Middle Name:PHONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-1231
Mailing Address - Country:US
Mailing Address - Phone:650-521-0861
Mailing Address - Fax:
Practice Address - Street 1:2690 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-1231
Practice Address - Country:US
Practice Address - Phone:650-521-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker