Provider Demographics
NPI:1467493015
Name:NGUYEN, JOCELYN (MD)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
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 1:9520W PALM LN 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4403
Mailing Address - Country:US
Mailing Address - Phone:877-809-5092
Mailing Address - Fax:623-876-9559
Practice Address - Street 1:7725 N 43RD AVE
Practice Address - Street 2:STE 510
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5770
Practice Address - Country:US
Practice Address - Phone:877-809-5092
Practice Address - Fax:623-815-9253
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H46736Medicare UPIN