Provider Demographics
NPI:1598718967
Name:NGUYEN, NHUT (MD)
Entity Type:Individual
Prefix:
First Name:NHUT
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3393 W 17TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4973
Mailing Address - Country:US
Mailing Address - Phone:928-539-5320
Mailing Address - Fax:
Practice Address - Street 1:1150 W 24TH ST STE F
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8368
Practice Address - Country:US
Practice Address - Phone:928-336-1442
Practice Address - Fax:928-336-7776
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ115971Medicare PIN