Provider Demographics
NPI:1043204571
Name:NGUYEN, KHANH P (MD)
Entity Type:Individual
Prefix:DR
First Name:KHANH
Middle Name:P
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 BARTELL DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-5546
Mailing Address - Country:US
Mailing Address - Phone:252-864-6358
Mailing Address - Fax:
Practice Address - Street 1:8264 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4127
Practice Address - Country:US
Practice Address - Phone:804-695-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201131208000000X
VA0101268121208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1315VOtherBCBS NC
NC370021704OtherRAILROAD MEDICARE
NC891315VMedicaid
NC891315VMedicaid
NC2004686AMedicare PIN