Healthcare Provider Details

I. General information

NPI: 1124406129
Provider Name (Legal Business Name): PAUL NGUYEN MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 MCDANIEL ST STE 230
N LAS VEGAS NV
89030-6309
US

IV. Provider business mailing address

PO BOX 36830
LAS VEGAS NV
89133-6830
US

V. Phone/Fax

Practice location:
  • Phone: 702-405-9080
  • Fax: 702-405-9240
Mailing address:
  • Phone: 702-487-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12178
License Number StateNV

VIII. Authorized Official

Name: PAUL NGUYEN
Title or Position: OWNER
Credential: MD
Phone: 702-685-0674