Healthcare Provider Details

I. General information

NPI: 1992740146
Provider Name (Legal Business Name): KHANH KIM NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 ANNAPOLIS RD
LANDOVER HILLS MD
20784-1307
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 301-276-3377
  • Fax:
Mailing address:
  • Phone: 48-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0077784
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: