Individual provider Active NPI

Dat Tien Nguyen, MD

  • Specialist
  • Modesto, CA
National Provider Identifier
1659346435
Registry record updated Jan 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G75447 Issued in CA
Practice address
4601 Dale Rd
Modesto, CA 95356-9718
Phone
(209) 735-4385
NPI assigned
Feb 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G75447 CA Primary

Addresses

Primary practice location

4601 Dale Rd
Modesto, CA 95356-9718

Mailing address

2324 Santa Rita Rd
Suite 6
Pleasanton, CA 94566-4152
Phone (925) 460-3205

Other names 1

  • Dr. Dat Tein Nguyen Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

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
I20040908000534 CA Practitioner - Colorectal Surgery (Proctology)Practitioner - Surgical OncologyPractitioner - General Surgery 1850367228 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)Also: General Surgery, Surgical Oncology
Education
University of Minnesota Medical School, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

4601 Dale Rd
Modesto, CA 95356-9718
Phone (209) 735-5000

Hospital & facility affiliations

  • Kaiser Foundation Hospital Manteca Hospital, Manteca, CA, CCN 050748

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G75447CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc CurrentSince Dec 16, 2015 Accepting new patients
Dat T Nguyen CurrentSince Aug 1, 2004 Accepting new patients
Permanente Medical Group, Inc CurrentSince Dec 16, 2015 Accepting new patients
Permanente Medical Group Inc Current Accepting new patients

Locations

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

4601 Dale Rd
Modesto, CA 95356
Phone (209) 557-1000

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

5565 W Las Positas Blvd
Pleasanton, CA 94588
Phone (803) 583-6735

5565 W Las Positas Blvd
Ste 360
Pleasanton, CA 94588
Phone (510) 734-0454

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

5601 Norris Canyon Rd
Ste 340
San Ramon, CA 94583
Phone (925) 786-5322

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834

Organizations & group practices 4

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 1

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": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1659346435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2324 SANTA RITA RD",
            "address_2": "SUITE 6",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945664152",
            "telephone_number": "925-460-3205",
            "fax_number": "925-460-3795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 DALE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569718",
            "telephone_number": "209-735-4385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "DAT",
        "middle_name": "TIEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G75447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4601 Dale Rd",
            "city": "Modesto",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953569718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DAT",
            "last_name": "NGUYEN",
            "middle_name": "TEIN",
            "prefix": "DR.",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Modesto, CA

Sources for this page

Verify at the official NPI Registry.