Provider Demographics
NPI:1013322783
Name:NGUYEN, JOHN-MINH (DO)
Entity Type:Individual
Prefix:
First Name:JOHN-MINH
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 BEMENT ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1703
Mailing Address - Country:US
Mailing Address - Phone:714-823-5892
Mailing Address - Fax:
Practice Address - Street 1:965 FEE RD
Practice Address - Street 2:A233
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-6569
Practice Address - Country:US
Practice Address - Phone:714-823-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-21
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010213842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry