Healthcare Provider Details

I. General information

NPI: 1235063546
Provider Name (Legal Business Name): MR. KHOA TONY NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S FLOYD ST
LOUISVILLE KY
40202-3822
US

IV. Provider business mailing address

555 S FLOYD ST
LOUISVILLE KY
40202-3822
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4056435
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: