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General NPI Number Information
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NPI Number | 1619316395
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Entity Type | Individual
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Provider Name | ALEXANDER THIEN AN NGOC NGUYEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 06/26/2024
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Provider Practice Location Address
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Address Line | 1201 W MAIN ST STE 100
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City | WATERBURY
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State | CT
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Zip | 06708-3105
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Country | US
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Telephone | 203-597-9100
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Fax | 203-401-6361
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Provider Business Mailing Address
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Address Line | 1201 W MAIN ST STE 100
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City | WATERBURY
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State | CT
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Zip | 06708-3105
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Country | US
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Telephone | 203-597-9100
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Fax | 203-401-6361
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 60860
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License Number State | CT
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Taxonomy #3
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME131460
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License Number State | FL
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