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General NPI Number Information
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NPI Number | 1598884413
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Entity Type | Individual
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Provider Name | KEVIN TRI NGUYEN M.D., PHD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 1968 PEACHTREE RD, NW 77 BUILDING, 5TH FLOOR
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City | ATLANTA
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State | GA
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Zip | 30309
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Country | US
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Telephone | 404-596-1157
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Fax |
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Provider Business Mailing Address
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Address Line | 1968 PEACHTREE RD, NW 77 BUILDING, 5TH FLOOR
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City | ATLANTA
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State | GA
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Zip | 30309
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Country | US
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Telephone | 404-596-1157
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301081515
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4301081515
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 070482
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License Number State | GA
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