Provider Demographics
NPI:1063034296
Name:NGUYEN, DENISE THI (DO)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 SUDLEY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4404
Mailing Address - Country:US
Mailing Address - Phone:703-656-9867
Mailing Address - Fax:
Practice Address - Street 1:8640 SUDLEY RD STE 203
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4404
Practice Address - Country:US
Practice Address - Phone:703-368-3161
Practice Address - Fax:703-656-9867
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101026867207Q00000X
VA0102207855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine