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General NPI Number Information
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NPI Number | 1669931713
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Entity Type | Individual
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Provider Name | MACKLIN HONG PHUOC NGUYEN MD
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Gender | Male
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 3535 N BELL SCHOOL RD
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City | ROCKFORD
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State | IL
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Zip | 61114-6624
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Country | US
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Telephone | 779-696-9400
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Fax | 779-696-9365
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Provider Business Mailing Address
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Address Line | 9260 W SUNSET RD STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89148-4903
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Country | US
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Telephone | 702-916-6904
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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 | 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 #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 036-172332
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License Number State | IL
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