Healthcare Provider Details

I. General information

NPI: 1316140924
Provider Name (Legal Business Name): VINH NGUYEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2007
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S PROSPECT ST
YPSILANTI MI
48198-7914
US

IV. Provider business mailing address

664 W WOODSIDE AVE
MADISON HEIGHTS MI
48071-5121
US

V. Phone/Fax

Practice location:
  • Phone: 734-547-1090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number5101016647
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: