Healthcare Provider Details

I. General information

NPI: 1174143580
Provider Name (Legal Business Name): CALVIN NGUYEN EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 11/27/2023
Certification Date: 04/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12099 GOVERNMENT CENTER PKWY
FAIRFAX VA
22035-5501
US

IV. Provider business mailing address

42785 GENERATION DR APT 601
ASHBURN VA
20147-4093
US

V. Phone/Fax

Practice location:
  • Phone: 571-242-2931
  • Fax:
Mailing address:
  • Phone: 571-242-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberB201805308
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: