Healthcare Provider Details

I. General information

NPI: 1124446430
Provider Name (Legal Business Name): HIEN NGOC NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 N SALEM ST STE 105
APEX NC
27523-6457
US

IV. Provider business mailing address

2172 N SALEM ST STE 105
APEX NC
27523-6457
US

V. Phone/Fax

Practice location:
  • Phone: 919-629-4360
  • Fax: 919-629-4362
Mailing address:
  • Phone: 919-629-4360
  • Fax: 919-629-4362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2016-00667
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number2016-00667
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: