Individual provider Active NPI

Tung Thanh Nguyen, DO

  • Family Medicine Physician
  • San Jose, CA
National Provider Identifier
1013982024
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A8238 Issued in CA
Practice address
621 Tully Rd
Suite 105
San Jose, CA 95111-1013
Phone
(408) 279-2988
Fax
(408) 279-2981
NPI assigned
Feb 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 20A8238 CA Primary

Addresses

Primary practice location

621 Tully Rd
Suite 105
San Jose, CA 95111-1013

Mailing address

621 Tully Rd
Suite 105
San Jose, CA 95111-1013
Phone (408) 279-2988

Other identifiers 1

IdentifierTypeStateIssuer
GR0088650MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070810000813 CA Practitioner - Family Practice 3375634975 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

621 Tully Rd
San Jose, CA 95111-1013
Phone (408) 279-2988

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
28.95 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
96.5

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A8238CAMDFamily Medicine Physician
8238CAMDSpeech-Language Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tung T. Nguyen, D.O., Inc. CurrentSince Jun 22, 2007 Accepting new patients
County of Santa Clara Past Accepting new patients

Locations

621 Tully Rd
Ste A105
San Jose, CA 95111
Phone (408) 279-2988

621 Tully Rd
#A105
San Jose, CA 95111
Phone (408) 279-2988

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377043200000",
    "number": "1013982024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 TULLY RD",
            "address_2": "SUITE 105",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951111013",
            "telephone_number": "408-279-2988",
            "fax_number": "408-279-2981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 TULLY RD",
            "address_2": "SUITE 105",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951111013",
            "telephone_number": "408-279-2988",
            "fax_number": "408-279-2981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "TUNG",
        "middle_name": "THANH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2013-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A8238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0088650",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.