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General NPI Number Information
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NPI Number | 1801235874
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Entity Type | Individual
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Provider Name | VANCUONG PHI NGUYEN M.D
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Gender | Male
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Dates
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Enumeration Date | 06/22/2013
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Last Update Date | 06/22/2013
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Provider Practice Location Address
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Address Line | 3990 JOHN R ST
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City | DETROIT
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State | MI
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Zip | 48201-2018
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Country | US
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Telephone | 313-330-2191
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Fax |
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Provider Business Mailing Address
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Address Line | 7216 16TH AVE SW
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City | SEATTLE
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State | WA
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Zip | 98106-1803
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Country | US
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Telephone | 313-638-2868
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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 | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 4301103617
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License Number State | MI
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