Healthcare Provider Details

I. General information

NPI: 1851889380
Provider Name (Legal Business Name): ANN XUAN NGUYEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 S MARYLAND PKWY
LAS VEGAS NV
89154-9900
US

IV. Provider business mailing address

10245 S MARYLAND PKWY
LAS VEGAS NV
89183-7397
US

V. Phone/Fax

Practice location:
  • Phone: 702-944-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO3029
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: