Provider Demographics
NPI:1346219482
Name:NGUYEN, ANH DAI KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:ANH DAI
Middle Name:KIM
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 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:6 PIDGEON HILL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6146
Practice Address - Country:US
Practice Address - Phone:703-444-7234
Practice Address - Fax:703-444-7201
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234418207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010126347Medicaid
VAG98547Medicare ID - Type Unspecified