Provider Demographics
NPI:1083685069
Name:NGUYEN, ALISON M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:M
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:PO BOX 36900
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-6900
Mailing Address - Country:US
Mailing Address - Phone:702-732-6000
Mailing Address - Fax:702-243-7531
Practice Address - Street 1:4 SUNSET WAY
Practice Address - Street 2:BLDG D
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2015
Practice Address - Country:US
Practice Address - Phone:702-732-6000
Practice Address - Fax:702-243-7531
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA789452085R0202X
NV117442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508857Medicaid
CA00A789450Medicaid
CAI31585Medicare UPIN
CAWA78945AMedicare ID - Type UnspecifiedGROUP# W7168
102216Medicare ID - Type Unspecified