Healthcare Provider Details

I. General information

NPI: 1790603025
Provider Name (Legal Business Name): PHUONG NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 E WILMETTE RD STE B
PALATINE IL
60074-6495
US

IV. Provider business mailing address

887 E WILMETTE RD STE B
PALATINE IL
60074-6495
US

V. Phone/Fax

Practice location:
  • Phone: 630-465-3963
  • Fax:
Mailing address:
  • Phone: 630-465-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: