Provider Demographics
NPI:1831388198
Name:NGUYEN, KEONI (DO)
Entity type:Individual
Prefix:
First Name:KEONI
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:THONG
Other - Middle Name:TRAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:244 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1657
Mailing Address - Country:US
Mailing Address - Phone:808-218-9109
Mailing Address - Fax:740-545-6760
Practice Address - Street 1:4834 SOCIALVILLE FOSTER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6827
Practice Address - Country:US
Practice Address - Phone:134-591-9885
Practice Address - Fax:513-459-1845
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010172207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology