Healthcare Provider Details

I. General information

NPI: 1023704053
Provider Name (Legal Business Name): PRISCILLA KHAI-LINH NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 TOWN CENTER DR STE 335
RESTON VA
20190-5900
US

IV. Provider business mailing address

2430 GALLOWS RD
DUNN LORING VA
22027-1224
US

V. Phone/Fax

Practice location:
  • Phone: 703-787-3322
  • Fax: 703-787-3380
Mailing address:
  • Phone: 818-632-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: