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NPI Code Detail

MEDICARE: DR. KHANH XONG NGUYEN DO

MEDICARE: DR. KHANH XONG NGUYEN DO
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
1207Q00000XFamily Medicine PhysicianOL60020645WA
2207Q00000XFamily Medicine Physician03645KY
3207Q00000XFamily Medicine PhysicianDO155697OR
4208D00000XGeneral Practice Physician20A9302CA
5207Q00000XFamily Medicine Physician64306MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841261088
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KHANH XONG NGUYEN DO
Provider Business Mailing Address
First Line : 7455 VILLAGE DR
Second Line :
City : LINO LAKES
State : MN
Zip : 55014-1181
Country : US
Telephone Number : 651-717-3400
Fax Number :
Provider Business Practice Location Address
First Line : 7455 VILLAGE DR
Second Line :
City : LINO LAKES
State : MN
Zip : 55014-1181
Country : US
Telephone Number : 651-717-3400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 09/11/2018

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