Healthcare Provider Details

I. General information

NPI: 1821385592
Provider Name (Legal Business Name): TOMMY NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4653 S LAKESHORE DR STE 3
TEMPE AZ
85282-7161
US

IV. Provider business mailing address

1525 S HIGLEY RD STE 104
GILBERT AZ
85296-5045
US

V. Phone/Fax

Practice location:
  • Phone: 480-456-8981
  • Fax:
Mailing address:
  • Phone: 480-875-9456
  • Fax: 480-546-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTPME6158
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74905
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301510341
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberTPME6158
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number4301510341
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberTHMD00139
License Number StateAZ
# 7
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number74905
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: