Healthcare Provider Details

I. General information

NPI: 1902674054
Provider Name (Legal Business Name): VY TUONG VU NGUYEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12695 MCMANUS BLVD STE 4A-B
NEWPORT NEWS VA
23602-4435
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 757-369-0439
  • Fax: 757-369-0513
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0110010163
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: