Healthcare Provider Details

I. General information

NPI: 1306979729
Provider Name (Legal Business Name): KHIET T NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD SUITE 620
BETHESDA MD
20817-1106
US

IV. Provider business mailing address

4110 ASPEN HILL RD SUIE 200
ROCKVILLE MD
20853-2853
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-6646
  • Fax: 301-530-0773
Mailing address:
  • Phone: 301-438-5150
  • Fax: 301-460-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD64347
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: