Provider Demographics
NPI:1073544599
Name:NGUYEN, HAI T
Entity Type:Individual
Prefix:
First Name:HAI
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:9499 W CHARLESTON BLVD
Practice Address - Street 2:SUITE #150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7150
Practice Address - Country:US
Practice Address - Phone:702-228-5477
Practice Address - Fax:702-255-7981
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045037207Q00000X
NV13702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073544599Medicaid
NVV111572-V111573Medicare PIN
NV1073544599Medicaid
NVP00915408OtherRAILROAD MEDICARE PIN