Provider Demographics
NPI:1104516855
Name:NGUYEN, KEVIN HOANG VUONG
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:HOANG VUONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4558
Mailing Address - Country:US
Mailing Address - Phone:251-626-0681
Mailing Address - Fax:
Practice Address - Street 1:806 WILSON AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4558
Practice Address - Country:US
Practice Address - Phone:251-626-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007194-C1122300000X
FLDN28911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist