Healthcare Provider Details

I. General information

NPI: 1326144841
Provider Name (Legal Business Name): KHANH HONG NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/12/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST FL 1
DOVER DE
19901-3530
US

IV. Provider business mailing address

880 CENTURY DR FL 1
MECHANICSBURG PA
17055-4375
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4401
  • Fax: 302-674-4129
Mailing address:
  • Phone: 717-691-3235
  • Fax: 717-691-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA96168
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number25MA08173600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberC1-0010053
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD421400
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: