Healthcare Provider Details

I. General information

NPI: 1235458456
Provider Name (Legal Business Name): BINH NGOC NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LAKEVIEW AVE APT 3
RICHMOND VA
23220-5702
US

IV. Provider business mailing address

2400 LAKEVIEW AVE APT 3
RICHMOND VA
23220-5702
US

V. Phone/Fax

Practice location:
  • Phone: 571-214-8162
  • Fax:
Mailing address:
  • Phone: 571-214-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116022286
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: