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General NPI Number Information
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NPI Number | 1962853135
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Entity Type | Individual
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Provider Name | PHUOC NAM VAN NGUYEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 13555 W MCDOWELL RD STE 205
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City | GOODYEAR
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State | AZ
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Zip | 85395-2626
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Country | US
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Telephone | 623-295-1190
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Fax |
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Provider Business Mailing Address
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Address Line | 5788 N KRISTI LN
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-3824
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Country | US
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Telephone | 714-383-0793
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OT017279
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 008120
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License Number State | AZ
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