Basic Information
| Provider Information | |||||||||
| NPI: | 1881954469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | MINH | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 SW RAMSEY AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975275535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414727810 | ||||||||
| FaxNumber: | 5414727811 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 SW RAMSEY AVE | ||||||||
| Address2: | |||||||||
| City: | GRANTS PASS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975275535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414727810 | ||||||||
| FaxNumber: | 5414727811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2012 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2015031854 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 4489-850 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2020-01163 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD206288 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1881954469 | 05 | NC | MEDICAID | 1881954469 | 05 | WI | MEDICAID | PENDING | 01 | MO | RR MEDICARE | OTHER | MD206288 | 01 | OR | OREGON STATE BOARD | OTHER |