Healthcare Provider Details

I. General information

NPI: 1396940946
Provider Name (Legal Business Name): HOANG DANG NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIM DANG NGUYEN MD

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 E BASELINE RD SUITE 200
GILBERT AZ
85234-2471
US

IV. Provider business mailing address

PO BOX 772
GILBERT AZ
85299-0772
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-2199
  • Fax: 480-507-2218
Mailing address:
  • Phone: 480-507-2199
  • Fax: 480-507-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP1-0017416
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37837
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number37837
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: