Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0401416904 | VA |
NPI | 1023495298 |
---|---|
Provider Name | Dr. Phillip Nguyen |
First Address | Reston, VA 20190-3237 |
Second Address | Reston, VA 20190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2015 |
Last Update Date | 04/08/2020 |