Provider Demographics
NPI:1619663069
Name:NGUYEN, NIXON VAN (PA STUDENT)
Entity Type:Individual
Prefix:
First Name:NIXON
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1371 WAHANE ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3127
Mailing Address - Country:US
Mailing Address - Phone:336-429-2408
Mailing Address - Fax:
Practice Address - Street 1:91-1371 WAHANE ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-3127
Practice Address - Country:US
Practice Address - Phone:336-429-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program