Basic Information
| Provider Information | |||||||||
| NPI: | 1932425261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | DAN-VINH | ||||||||
| MiddleName: | PHAM | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4150 V ST | ||||||||
| Address2: | SUITE 3400 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167344597 | ||||||||
| FaxNumber: | 9167347924 | ||||||||
| Practice Location | |||||||||
| Address1: | 4150 V ST | ||||||||
| Address2: | SUITE 3400 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167344597 | ||||||||
| FaxNumber: | 9167347924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2010 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101253878 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1932425261 | 01 | VA | UNITED HEALTHCARE | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | AETNA | OTHER | 1932425261 | 01 | VA | VIRGINIA PREMIER HEALTH PLAN | OTHER | 1932425261 | 01 | VA | COVENTRY NETWORK | OTHER | 1932425261 | 05 | VA | MEDICAID | 10112168 | 01 | VA | OPTIMA HEALTH | OTHER | 497840 | 01 | VA | ANTHEM BC/BS | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | -028 | 01 | VA | TRICARE/CHAMPUS | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | CORVEL | OTHER | 1932425261 | 05 | NC | MEDICAID |