Provider Demographics
NPI:1609762947
Name:NGUYEN, VI NGOC PHUONG
Entity type:Individual
Prefix:
First Name:VI
Middle Name:NGOC PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1963 S OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2818
Mailing Address - Country:US
Mailing Address - Phone:678-670-6610
Mailing Address - Fax:
Practice Address - Street 1:335 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2108
Practice Address - Country:US
Practice Address - Phone:317-631-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program