Provider Demographics
NPI:1275741969
Name:NGUYEN, MAI PHUONG THUY (MD)
Entity Type:Individual
Prefix:
First Name:MAI PHUONG
Middle Name:THUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10047
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96162
Mailing Address - Country:US
Mailing Address - Phone:530-587-5877
Mailing Address - Fax:530-582-6896
Practice Address - Street 1:10356 DONNER PASS ROAD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96162
Practice Address - Country:US
Practice Address - Phone:530-587-5877
Practice Address - Fax:530-587-5877
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-12-28
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-12-28
Provider Licenses
StateLicense IDTaxonomies
CAG0703012084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry