Healthcare Provider Details

I. General information

NPI: 1982698528
Provider Name (Legal Business Name): DAT D NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 E BEVERLY AVE STE 203
KINGMAN AZ
86409-3593
US

IV. Provider business mailing address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

V. Phone/Fax

Practice location:
  • Phone: 928-757-3133
  • Fax: 928-757-3136
Mailing address:
  • Phone: 928-757-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number36837
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD2025-0009
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number36837
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: