Healthcare Provider Details

I. General information

NPI: 1417643321
Provider Name (Legal Business Name): ALEXANDER VAN TAM NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N MAIN ST
FUQUAY VARINA NC
27526-8573
US

IV. Provider business mailing address

PO BOX 803854
KANSAS CITY MO
64180-3854
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-6513
  • Fax: 919-341-3379
Mailing address:
  • Phone: 919-350-0351
  • Fax: 919-350-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2026-02282
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: