Provider Demographics
NPI:1275947103
Name:NGUYEN, PHUONG DUONG THOAI (DO)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:DUONG THOAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 SILVER CREEK RD STE 111&113
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7904
Mailing Address - Country:US
Mailing Address - Phone:928-704-7163
Mailing Address - Fax:928-704-7140
Practice Address - Street 1:1055 W FAIRVIEW ST STE B
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-5106
Practice Address - Country:US
Practice Address - Phone:509-397-2675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007988208600000X
390200000X
WAOP61447850208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program