Healthcare Provider Details

I. General information

NPI: 1548013196
Provider Name (Legal Business Name): THANH THANH T NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 ALBROOK DR
DENVER CO
80239-4604
US

IV. Provider business mailing address

1092 WESTERN AVE
GREEN BAY WI
54303-1853
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-4000
  • Fax:
Mailing address:
  • Phone: 920-328-7594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0010368
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: