Healthcare Provider Details

I. General information

NPI: 1144332602
Provider Name (Legal Business Name): VAN MINH NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER DALLAS VA MEDICAL CENTER
DALLAS TX
75216
US

IV. Provider business mailing address

5901 VALLEYBROOK DR
PLANO TX
75093-7739
US

V. Phone/Fax

Practice location:
  • Phone: 800-849-3597
  • Fax: 214-857-2023
Mailing address:
  • Phone: 214-455-9385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL0456
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: