Provider Demographics
NPI:1740379379
Name:NGUYEN-ANTONIO, PHUONG HOAI (DO)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:HOAI
Last Name:NGUYEN-ANTONIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 WESTGATE CENTER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3051
Mailing Address - Country:US
Mailing Address - Phone:336-760-6667
Mailing Address - Fax:
Practice Address - Street 1:1373 WESTGATE CENTER DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2934
Practice Address - Country:US
Practice Address - Phone:336-760-6667
Practice Address - Fax:336-760-6648
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry