Basic Information
| Provider Information | |||||||||
| NPI: | 1396163309 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | KHOA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | D.P.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 661 GOODLETTE RD N | ||||||||
| Address2: | STE 103 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394303668 | ||||||||
| FaxNumber: | 8666503324 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079606136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739715000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2014 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 0 | PA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.