=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306979729
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHIET T NGUYEN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 12/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10215 FERNWOOD RD SUITE 620
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20817-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-530-6646
-----------------------------------------------------
Fax | 301-530-0773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4110 ASPEN HILL RD SUIE 200
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20853-2853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-438-5150
-----------------------------------------------------
Fax | 301-460-0199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | D64347
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------