Basic Information
| Provider Information | |||||||||
| NPI: | 1093370355 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | HAU | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10624 S EASTERN AVE # A-955 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890522982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024077700 | ||||||||
| FaxNumber: | 7023888431 | ||||||||
| Practice Location | |||||||||
| Address1: | 10624 S EASTERN AVE # A-955 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890522982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024077700 | ||||||||
| FaxNumber: | 7023888431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2019 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | SL1448 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.