Healthcare Provider Details

I. General information

NPI: 1215086152
Provider Name (Legal Business Name): HOA VAN NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 NORTH MARINE CORPS DRIVE AMERICAN MEDICAL CENTER
UPPER TUMON GU
96913
US

IV. Provider business mailing address

1244 N MARINE CORPS DR
TAMUNING GU
96913-4308
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-8262
  • Fax: 671-647-8257
Mailing address:
  • Phone: 671-647-8262
  • Fax: 671-647-8257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM001173
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: