Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | DO2633 | NV |
N | 207QG0300X | Family Doctor - Geriatric Medicine | DR0057649 | CO |
NPI | 1063810935 |
---|---|
Provider Name | Michael H. Nguyen |
First Address | Las Vegas, NV 89193-8978 |
Second Address | Las Vegas, NV 89145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2014 |
Last Update Date | 04/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063810935 | (05) | NV |
DO2633 | STATE LICENSE (01) | NV |