Provider Demographics
NPI:1164483517
Name:VO-NGUYEN, TRANG T (MD)
Entity Type:Individual
Prefix:
First Name:TRANG
Middle Name:T
Last Name:VO-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 1:25055 RIDING PLZ
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5917
Mailing Address - Country:US
Mailing Address - Phone:703-327-8200
Mailing Address - Fax:703-327-7800
Practice Address - Street 1:25055 RIDING PLZ
Practice Address - Street 2:SUITE 140
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5917
Practice Address - Country:US
Practice Address - Phone:703-327-8200
Practice Address - Fax:703-327-7800
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246352207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN469726000Medicaid
110005367Medicare ID - Type Unspecified
MN469726000Medicaid