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General NPI Number Information
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NPI Number | 1215080668
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Entity Type | Individual
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Provider Name | PHONG NGUYEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 8008 WESTPARK DR
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City | MC LEAN
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State | VA
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Zip | 22102-3109
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Country | US
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Telephone | 703-287-1075
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Fax | 703-287-1076
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Provider Business Mailing Address
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Address Line | 2101 E JEFFERSON ST KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
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City | ROCKVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone | 301-816-6660
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Fax | 301-816-6308
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 0101043746
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License Number State | VA
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