Basic Information
| Provider Information | |||||||||
| NPI: | 1831317551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | VU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 N STEPHANIE ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029523350 | ||||||||
| FaxNumber: | 7029523365 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 WIGWAM PKWY | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028561400 | ||||||||
| FaxNumber: | 7028561401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 12234 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 12234 | 01 | NV | MEDICAL LICENSE | OTHER | 100512540 | 05 | NV | MEDICAID |