Provider Demographics
NPI:1255350229
Name:NGUYEN, JENNY (DPM)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E GUDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1341
Mailing Address - Country:US
Mailing Address - Phone:301-933-7133
Mailing Address - Fax:301-933-7137
Practice Address - Street 1:8028 RITCHIE HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1075
Practice Address - Country:US
Practice Address - Phone:410-768-5800
Practice Address - Fax:410-768-5806
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01431213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD442183307Medicaid
MD010221100Medicaid
MD442183307Medicaid
MD010221100Medicaid