Healthcare Provider Details

I. General information

NPI: 1831388198
Provider Name (Legal Business Name): KEONI NGUYEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THONG TRAN NGUYEN DO

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4834 SOCIALVILLE FOSTER RD
MASON OH
45040-6827
US

IV. Provider business mailing address

244 COLLINS AVE
COLUMBUS OH
43215-1657
US

V. Phone/Fax

Practice location:
  • Phone: 134-591-9885
  • Fax: 513-459-1845
Mailing address:
  • Phone: 808-218-9109
  • Fax: 740-545-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number34.010172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: