Healthcare Provider Details

I. General information

NPI: 1497675722
Provider Name (Legal Business Name): NHAN NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEX NGUYEN MD

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS CIR
SYRACUSE NY
13210-1634
US

IV. Provider business mailing address

908 HARRISON ST APT 111
SYRACUSE NY
13210-2365
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5540
  • Fax:
Mailing address:
  • Phone: 315-464-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: