Provider Demographics
NPI:1063417509
Name:NGUYEN, NGHI V (MD)
Entity type:Individual
Prefix:DR
First Name:NGHI
Middle Name:V
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NGHI
Other - Middle Name:VINH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10580 ARROWHEAD DRIVE
Mailing Address - Street 2:FAIRFAX HEALTH CENTER
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:571-432-2680
Mailing Address - Fax:571-432-2795
Practice Address - Street 1:10580 ARROWHEAD DRIVE
Practice Address - Street 2:FAIRFAX HEALTH CENTER
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030
Practice Address - Country:US
Practice Address - Phone:571-432-2680
Practice Address - Fax:571-432-2795
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010021081Medicaid
002552M87Medicare ID - Type Unspecified
VA010021081Medicaid