Healthcare Provider Details

I. General information

NPI: 1467376509
Provider Name (Legal Business Name): MAI PHUONG BACH NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NGUYEN MAI PHUONG BACH

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONNECTICUT AVE NW STE 500
WASHINGTON DC
20036-1736
US

IV. Provider business mailing address

1350 CONNECTICUT AVE NW STE 500
WASHINGTON DC
20036-1736
US

V. Phone/Fax

Practice location:
  • Phone: 202-969-2274
  • Fax:
Mailing address:
  • Phone: 202-969-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberTP263-017
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: