Provider Demographics
NPI:1891789038
Name:NGUYEN, KHANG V (MD)
Entity Type:Individual
Prefix:DR
First Name:KHANG
Middle Name:V
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 1:1832 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1832 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1901
Practice Address - Country:US
Practice Address - Phone:617-469-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
043243146OtherHARVARD PILGRIM
043243146OtherHCVM
J26814OtherHMO BLUE
NE043243146OtherUNITED HLTHCARE OF NE
J26814OtherBLUE CARE ELECT
M15986OtherBLUE CROSS INDEMNITY
0405762OtherEVERCARE
6000577OtherHARVARD PILGRIM
J26814OtherBLUE CROSS INDEMNITY
MA2018900Medicaid
21236592777OtherBEECH STREET
043243146OtherGREAT WEST HEALTHCARE
1377862001OtherCIGNA
3554363OtherAETNA HEALTH PLAN
043243146OtherGREAT WEST HEALTHCARE
A35944Medicare ID - Type Unspecified
0405762OtherEVERCARE
J26814OtherBLUE CARE ELECT
J26814OtherBLUE CROSS INDEMNITY
P00048147Medicare ID - Type UnspecifiedRR