Individual provider Active NPI

Mark Phuoc Nguyen, PSY.D

  • Clinical Psychologist
  • San Francisco, CA
National Provider Identifier
1891044640
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY29174 Issued in CA
Practice address
1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723
Phone
(888) 663-6331
NPI assigned
Sep 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY29174 CA Primary

Addresses

Primary practice location

1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723

Mailing address

1 Embarcadero Ctr Ste 1900
San Francisco, CA 94111-3723

Other practice location 1

4211 Avalon Blvd
Los Angeles, CA 90011-5622
Phone (323) 233-0425

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180507002292 CA Practitioner - Clinical Psychologist 9537423116 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
One Medical Group IncGroup PAC ID 2567623739, 330 clinicians

Practice addresses (Care Compare)

2 Embarcadero Ctr
Lbby Level
San Francisco, CA 94111-3823
Phone (888) 663-6331

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PSY29174CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
One Medical Group, Inc CurrentSince Dec 11, 2023 Accepting new patients
One Medical Group, Inc. CurrentSince Dec 11, 2023 Accepting new patients
Corrections and Rehabilitation-Headquarters PastSince Mar 22, 2020 Accepting new patients

Locations

2 Embarcadero Ctr
Lbby
San Francisco, CA 94111
Phone (415) 529-4566

559 Clay St
#200
San Francisco, CA 94111
Phone (415) 830-4744

1 Embarcadero Ctr
Ste 1900
San Francisco, CA 94111

Organizations & group practices 3

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": "1346889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1891044640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 EMBARCADERO CTR STE 1900",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 EMBARCADERO CTR STE 1900",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941113723",
            "telephone_number": "888-663-6331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4211 Avalon Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900115622",
            "country_code": "US",
            "telephone_number": "323-233-0425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "MARK",
        "middle_name": "PHUOC",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-06",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY29174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.