Healthcare Provider Details

I. General information

NPI: 1538266234
Provider Name (Legal Business Name): NAM PHONG NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW HUH B810
WASHINGTON DC
20060
US

IV. Provider business mailing address

2041 GEORGIA AVE NW TOWER 3400
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-1421
  • Fax:
Mailing address:
  • Phone: 202-865-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number30912
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD16513
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: