Provider Demographics
NPI:1669931713
Name:NGUYEN, MACKLIN HONG PHUOC (MD)
Entity type:Individual
Prefix:
First Name:MACKLIN
Middle Name:HONG PHUOC
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 1:9260 W SUNSET RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4903
Mailing Address - Country:US
Mailing Address - Phone:702-916-6904
Mailing Address - Fax:
Practice Address - Street 1:3535 N BELL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6624
Practice Address - Country:US
Practice Address - Phone:779-696-9400
Practice Address - Fax:779-696-9365
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036-1723322085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program