Provider Demographics
NPI:1447284971
Name:NGUYEN, PHU TAN
Entity type:Individual
Prefix:DR
First Name:PHU
Middle Name:TAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PHU
Other - Middle Name:TAN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8901 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-3223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:202-741-2911
Practice Address - Fax:202-741-2921
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23644208D00000X
MDD0095447207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE23644Medicare UPIN