Healthcare Provider Details

I. General information

NPI: 1659583854
Provider Name (Legal Business Name): KENNY NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E CENTRAL AVE
WINTER HAVEN FL
33880-3053
US

IV. Provider business mailing address

325 1ST ST N
WINTER HAVEN FL
33881-4111
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-1191
  • Fax:
Mailing address:
  • Phone: 863-293-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME99405
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: