Individual provider Active NPI

Dennis Nguyen

  • Family Nurse Practitioner
  • Elk Grove, CA
National Provider Identifier
1790317873
Registry record updated Apr 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95013056 Issued in CA
Practice address
9428 Havenview Way
Elk Grove, CA 95624-6032
Phone
(510) 566-8398
NPI assigned
Feb 6, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95013056 CA Primary

Addresses

Primary practice location

9428 Havenview Way
Elk Grove, CA 95624-6032

Mailing address

4610 X St
Sacramento, CA 95817-2200
Phone (916) 734-2145

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200526002819 CA Practitioner - Nurse Practitioner 3678994811 Reassigns benefits to 4 organizations
Practice locations: Sacramento, CA

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Team Physicians of California Medical Group IncGroup PAC ID 8224945084, 92 clinicians

Practice addresses (Care Compare)

975 S Fairmont Ave
Lodi, CA 95240-5118
Phone (209) 334-3411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Team Physicians of California Medical Group Inc CurrentSince Mar 1, 2025 Accepting new patients
Clinic Services of California Medical Group Inc CurrentSince Mar 1, 2025 Accepting new patients
Medicine Physicians Incorporated CurrentSince May 19, 2020 Accepting new patients
Umer Malik Corporation Past Accepting new patients

Locations

1235 W Vine St
Ste 20
Lodi, CA 95240
Phone (209) 339-7600

975 S Fairmont Ave
Lodi, CA 95240
Phone (209) 339-7575

4250 Auburn Blvd
Sacramento, CA 95841
Phone (916) 305-7032

7700 Folsom Blvd
Sacramento, CA 95826
Phone (916) 386-3000

525 W Acacia St
Stockton, CA 95203
Phone (209) 944-5410

Organizations & group practices 5

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": "1580947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585872000000",
    "number": "1790317873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4610 X ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172200",
            "telephone_number": "916-734-2145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9428 HAVENVIEW WAY",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "956246032",
            "telephone_number": "510-566-8398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "DENNIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-06",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95013056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove, CA

Sources for this page

Verify at the official NPI Registry.