Provider Demographics
NPI:1801357041
Name:NGUYEN, PHU N (MAC)
Entity Type:Individual
Prefix:
First Name:PHU
Middle Name:N
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 ALLENTOWN RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4520
Mailing Address - Country:US
Mailing Address - Phone:301-678-9411
Mailing Address - Fax:
Practice Address - Street 1:5627 ALLENTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4520
Practice Address - Country:US
Practice Address - Phone:301-678-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02434171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty