Provider Demographics
NPI:1861402505
Name:NGUYEN, SONNY VAN (MD)
Entity type:Individual
Prefix:DR
First Name:SONNY
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 480456
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33448-0456
Mailing Address - Country:US
Mailing Address - Phone:561-374-8811
Mailing Address - Fax:561-374-8822
Practice Address - Street 1:10151 ENTERPRISE CENTER BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3759
Practice Address - Country:US
Practice Address - Phone:561-374-8811
Practice Address - Fax:561-374-8822
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265409100Medicaid
FL265409100Medicaid
H74340Medicare UPIN