MEDICARE: MAI HOANG NGUYEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A94851	CA
2	207N00000X	Dermatology Physician	0101244058	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275612319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAI HOANG NGUYEN MD

Provider Business Mailing Address
First Line	:	410 MAPLE AVE W STE 3
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4224
Country	:	US
Telephone Number	:	703-281-3626
Fax Number	:	703-281-3615

Provider Business Practice Location Address
First Line	:	410 MAPLE AVE W STE 3
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4224
Country	:	US
Telephone Number	:	703-281-3626
Fax Number	:	703-281-3615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	12/04/2018

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Directions to “ MAI HOANG NGUYEN MD” Practice Location

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