Healthcare Provider Details

I. General information

NPI: 1992997522
Provider Name (Legal Business Name): DAO M NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NW 12TH AVE # 803 BOX 016960 M851
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE EAST TOWER 3072
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-2607
  • Fax: 305-243-8470
Mailing address:
  • Phone: 305-585-5271
  • Fax: 305-547-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME99693
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME99693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: