Provider Demographics
NPI:1417601667
Name:NGUYEN, LE PHUONG
Entity Type:Individual
Prefix:
First Name:LE PHUONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PLEASANT HILL RD NW STE B201
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8751
Mailing Address - Country:US
Mailing Address - Phone:832-955-6934
Mailing Address - Fax:
Practice Address - Street 1:550 PLEASANT HILL RD NW STE B201
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8751
Practice Address - Country:US
Practice Address - Phone:832-955-6934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide