Healthcare Provider Details

I. General information

NPI: 1952721706
Provider Name (Legal Business Name): ANDREW NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WASHINGTON AVE SE
MINNEAPOLIS MN
55414-2924
US

IV. Provider business mailing address

7533 11TH AVE S
RICHFIELD MN
55423-4504
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-7422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number67418
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: