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General NPI Number Information
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NPI Number | 1164417010
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Entity Type | Individual
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Provider Name | KHANH Q NGUYEN PA C
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Gender | Male
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 601 E ROLLINS ST
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City | ORLANDO
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State | FL
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Zip | 32803-1248
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Country | US
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Telephone | 407-609-0095
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Fax | 407-609-0096
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Provider Business Mailing Address
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Address Line | PO BOX 4059
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City | WAYNE
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State | NJ
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Zip | 07474-4059
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Country | US
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Telephone | 973-826-8291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9102312
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9102312
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License Number State | FL
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