Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS039458 | PA |
NPI | 1023384674 |
---|---|
Provider Name | Dr. Phuong M Nguyen |
First Address | Apo, AP 96367-0089 |
Second Address | Apo, AP 96368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2012 |
Last Update Date | 15/03/2021 |