Provider Demographics
NPI:1164606158
Name:NGUYEN, HAN NGOC (MD)
Entity Type:Individual
Prefix:DR
First Name:HAN
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W. SPRING VALLEY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1323
Mailing Address - Country:US
Mailing Address - Phone:201-881-0107
Mailing Address - Fax:
Practice Address - Street 1:255 W. SPRING VALLEY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07601-1323
Practice Address - Country:US
Practice Address - Phone:201-881-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08081600207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease