Basic Information
| Provider Information | |||||||||
| NPI: | 1134681281 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NGUYEN | ||||||||
| FirstName: | BINH | ||||||||
| MiddleName: | THANH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19404 N 115TH DR | ||||||||
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| City: | SURPRISE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853782603 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3269 N STOCKTON HILL RD | ||||||||
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| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864093619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286818577 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2019 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 7576 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.