Healthcare Provider Details

I. General information

NPI: 1225978224
Provider Name (Legal Business Name): LISA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W CHARLESTON BLVD
LAS VEGAS NV
89102-2325
US

IV. Provider business mailing address

8324 HOLLOW WHARF DR
LAS VEGAS NV
89128-7425
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberLL4696
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: