Healthcare Provider Details

I. General information

NPI: 1588872261
Provider Name (Legal Business Name): HUNG NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W BROWARD BLVD
FORT LAUDERDALE FL
33312-1638
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-7313
  • Fax: 954-527-6003
Mailing address:
  • Phone: 954-463-7313
  • Fax: 954-527-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME 103610
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME 103610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: