MEDICARE: VU NGUYEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	D012533	AZ

General Provider Information

NPI Number	:	1689463358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VU NGUYEN

Provider Business Mailing Address
First Line	:	2273 SUNRISE TRL
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-4410
Country	:	US
Telephone Number	:	408-833-5028
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 FRONTAGE RD
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-8154
Country	:	US
Telephone Number	:	928-704-0220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	06/12/2025

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Directions to “ VU NGUYEN ” Practice Location

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