Healthcare Provider Details

I. General information

NPI: 1528083615
Provider Name (Legal Business Name): LINH NGOC NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490A W ZIA RD
SANTA FE NM
87505-6996
US

IV. Provider business mailing address

490A W ZIA RD
SANTA FE NM
87505-6996
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-8900
  • Fax:
Mailing address:
  • Phone: 505-913-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberMD2004-0204
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: