Basic Information
| Provider Information | |||||||||
| NPI: | 1447284971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | PHU | ||||||||
| MiddleName: | TAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| OtherLastName: | NGUYEN | ||||||||
| OtherFirstName: | PHU | ||||||||
| OtherMiddleName: | TAN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11026 WICKSHIRE WAY | ||||||||
| Address2: | |||||||||
| City: | NORTH BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208523223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2403538893 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WALTER REED NATIONAL MILITARY CTR | ||||||||
| Address2: | 8901 ROCKVILLE PIKE | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012954810 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 02/22/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 23644 | NE | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.