Healthcare Provider Details

I. General information

NPI: 1235091679
Provider Name (Legal Business Name): VAN NGUYEN LLC PAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10327 DALLINGTON ST
LAS VEGAS NV
89141-9032
US

IV. Provider business mailing address

10327 DALLINGTON ST
LAS VEGAS NV
89141-9032
US

V. Phone/Fax

Practice location:
  • Phone: 714-360-9165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: VAN NGUYEN
Title or Position: OWNER
Credential: PA-C
Phone: 714-360-9165