Provider Demographics
NPI:1063470136
Name:NGUYEN, VIET (MD)
Entity Type:Individual
Prefix:MR
First Name:VIET
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:VIET
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1612 UTE BLVD
Mailing Address - Street 2:112
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-7500
Mailing Address - Country:US
Mailing Address - Phone:435-655-3309
Mailing Address - Fax:435-655-3392
Practice Address - Street 1:1612 UTE BLVD
Practice Address - Street 2:112
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-7500
Practice Address - Country:US
Practice Address - Phone:435-655-3309
Practice Address - Fax:435-655-3392
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5151398-8905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH60890Medicare UPIN