Healthcare Provider Details

I. General information

NPI: 1043316680
Provider Name (Legal Business Name): KHANGHY D NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KHANG HY DUY NGUYEN DO

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E COLUMBIA ST
MASON MI
48854-1381
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-244-8900
  • Fax: 517-244-8911
Mailing address:
  • Phone: 517-364-6253
  • Fax: 517-364-6208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101016035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: