Healthcare Provider Details

I. General information

NPI: 1265744064
Provider Name (Legal Business Name): JENNIFER NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 SUMMERGROVE CRESCENT
MISSISSAUGA ONTARIO
L5M 3Z4
CA

IV. Provider business mailing address

1624 SUMMERGROVE CRESCENT
MISSISSAUGA ONTARIO
L5M 3Z4
CA

V. Phone/Fax

Practice location:
  • Phone: 905-826-8575
  • Fax:
Mailing address:
  • Phone: 905-826-8575
  • 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 StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: