Healthcare Provider Details

I. General information

NPI: 1326742230
Provider Name (Legal Business Name): PAUL NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S COUNTRY CLUB DR STE 3
MESA AZ
85210-5162
US

IV. Provider business mailing address

2331 W LA SALLE ST
PHOENIX AZ
85041-3539
US

V. Phone/Fax

Practice location:
  • Phone: 480-827-5500
  • Fax:
Mailing address:
  • Phone: 623-251-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: