Provider Demographics
NPI:1780866954
Name:NGUYEN, SON HOANG (MD)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:HOANG
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 1:4461 STARKEY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0622
Mailing Address - Country:US
Mailing Address - Phone:540-345-4946
Mailing Address - Fax:540-982-7164
Practice Address - Street 1:4461 STARKEY RD STE 201
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-0622
Practice Address - Country:US
Practice Address - Phone:540-345-4946
Practice Address - Fax:540-772-3822
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244213207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780866954Medicaid
VAP00731318Medicare PIN
VA020198L84Medicare PIN
VAP00779077Medicare PIN
VA1780866954Medicaid