Individual provider Active NPI

Diane Ngoc Nguyen, LMFT

  • Marriage & Family Therapist
  • San Jose, CA
National Provider Identifier
1083962419
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
100402 Issued in CA
Practice address
1101 S Winchester Blvd
San Jose, CA 95128-3901
Phone
(408) 758-0805
NPI assigned
Aug 15, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 100402 CA Primary

Addresses

Primary practice location

1101 S Winchester Blvd
San Jose, CA 95128-3901

Mailing address

1101 S Winchester Blvd Ste H190
San Jose, CA 95128-3903
Phone (408) 710-3870

Other practice location 1

310 8th St
Suite 201
Oakland, CA 94607-6526
Phone (408) 710-3870

Other names 1

  • Diane Ngoc Nguyen Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
100402CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Agere Trauma Work PSC Marriage & Family Therapist CurrentSince Jun 9, 2024 Accepting new patients

Locations

2033 Gateway Pl
Unit 664
San Jose, CA 95110
Phone (408) 758-0805

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1344988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1083962419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 S WINCHESTER BLVD STE H190",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951283903",
            "telephone_number": "408-710-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 S WINCHESTER BLVD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951283901",
            "telephone_number": "408-758-0805"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 8th St",
            "address_2": "Suite 201",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946076526",
            "country_code": "US",
            "telephone_number": "408-710-3870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "DIANE",
        "middle_name": "NGOC",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "100402",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "NGUYEN",
            "middle_name": "NGOC",
            "credential": "LMFT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.