Healthcare Provider Details

I. General information

NPI: 1922454172
Provider Name (Legal Business Name): PETER NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ALABAMA AVE SE
WASHINGTON DC
20032-4540
US

IV. Provider business mailing address

1270 4TH ST NE APT 1203
WASHINGTON DC
20002-6899
US

V. Phone/Fax

Practice location:
  • Phone: 202-299-5000
  • Fax:
Mailing address:
  • Phone: 714-925-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberDO034764
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: