Healthcare Provider Details

I. General information

NPI: 1639495617
Provider Name (Legal Business Name): DAN HAI NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LONG HAI NGUYEN

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 06/13/2021
Certification Date: 06/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 RIDGEGATE PKWY
LONE TREE CO
80124
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax: 303-344-7715
Mailing address:
  • Phone: 303-338-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number0052192
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0052192
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: