Provider Demographics
NPI:1518213578
Name:HELLER, AI QUOC NGUYEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:AI QUOC
Middle Name:NGUYEN
Last Name:HELLER
Suffix:
Gender:M
Credentials:DPM
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 50605
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0605
Mailing Address - Country:US
Mailing Address - Phone:702-623-9585
Mailing Address - Fax:702-586-7306
Practice Address - Street 1:8420 W WARM SPRINGS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3624
Practice Address - Country:US
Practice Address - Phone:702-740-5327
Practice Address - Fax:702-740-5328
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1205213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV100840Medicare PIN
NVGI1272Medicare PIN
NV6141500001Medicare NSC