Healthcare Provider Details

I. General information

NPI: 1588361810
Provider Name (Legal Business Name): NHAN THANH NGUYEN NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 N LITCHFIELD RD STE 200
GOODYEAR AZ
85395-1253
US

IV. Provider business mailing address

901 S COUNTRY CLUB DR APT 2121
MESA AZ
85210-3556
US

V. Phone/Fax

Practice location:
  • Phone: 623-643-9598
  • Fax: 623-478-0960
Mailing address:
  • Phone: 320-237-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number22-1762
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: