Healthcare Provider Details

I. General information

NPI: 1720139496
Provider Name (Legal Business Name): TRONG V NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 HARRISON AVE SUITE 308
BOSTON MA
02111-1924
US

IV. Provider business mailing address

65 HARRISON AVE SUITE 308
BOSTON MA
02111-1924
US

V. Phone/Fax

Practice location:
  • Phone: 617-423-9088
  • Fax: 617-423-7332
Mailing address:
  • Phone: 617-423-9088
  • Fax: 617-423-7332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberAN3244263
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: