Healthcare Provider Details

I. General information

NPI: 1811928237
Provider Name (Legal Business Name): HANSON NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DONG NGUYEN MD

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 E IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34744-4416
US

IV. Provider business mailing address

2037 E IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34744-4416
US

V. Phone/Fax

Practice location:
  • Phone: 407-288-8157
  • Fax: 855-633-7729
Mailing address:
  • Phone: 407-749-8877
  • Fax: 855-633-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME95889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: