Healthcare Provider Details

I. General information

NPI: 1790019917
Provider Name (Legal Business Name): SUMMER HANH NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 JEFFERSON ST NE
ALBUQUERQUE NM
87109-2155
US

IV. Provider business mailing address

PO BOX 6880
SANTA FE NM
87502-6880
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-9454
  • Fax: 505-888-9644
Mailing address:
  • Phone: 505-983-0891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2024-1194
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: