Healthcare Provider Details

I. General information

NPI: 1598884413
Provider Name (Legal Business Name): KEVIN TRI NGUYEN M.D., PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD, NW 77 BUILDING, 5TH FLOOR
ATLANTA GA
30309
US

IV. Provider business mailing address

1968 PEACHTREE RD, NW 77 BUILDING, 5TH FLOOR
ATLANTA GA
30309
US

V. Phone/Fax

Practice location:
  • Phone: 404-596-1157
  • Fax:
Mailing address:
  • Phone: 404-596-1157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301081515
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301081515
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number70482
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: