1235779505 NPI number — JASMINE T. NGUYEN., O.D., A PROFESSIONAL CORPORATION

Table of content: MAHASIN TARIQ HASSAN TAHA (NPI 1427601830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235779505 NPI number — JASMINE T. NGUYEN., O.D., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JASMINE T. NGUYEN., O.D., A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235779505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5896 IRON HORSE PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-721-5720
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
685 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94105-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-896-0680
Provider Business Practice Location Address Fax Number:
415-896-0352
Provider Enumeration Date:
01/14/2020

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
JASMINE
Authorized Official Middle Name:
THUY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
815-721-5720

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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