Healthcare Provider Details

I. General information

NPI: 1427584200
Provider Name (Legal Business Name): HOANVU NGOC NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG/SGGE 101 BODIN CIR
TRAVIS AFB CA
94535-1800
US

IV. Provider business mailing address

4150 V ST STE 2100
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberDR.0063822
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0063822
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: