Provider Demographics
NPI:1245624220
Name:NGUYEN, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E 11400 S STE 103
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-6947
Mailing Address - Country:US
Mailing Address - Phone:912-308-6496
Mailing Address - Fax:
Practice Address - Street 1:1025 E 11400 S STE 103
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-6947
Practice Address - Country:US
Practice Address - Phone:912-308-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116031447208200000X
FLTRN19445208600000X
UT12346972-1205208D00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice