Provider Demographics
NPI:1396330825
Name:NGUYEN, MARTIN TAI (PA)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:TAI
Last Name:NGUYEN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:3118 W THOMAS RD STE 713
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-5308
Mailing Address - Country:US
Mailing Address - Phone:602-456-2821
Mailing Address - Fax:602-347-6272
Practice Address - Street 1:1747 E MORTEN AVE STE 303
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-7625
Practice Address - Country:US
Practice Address - Phone:602-589-0370
Practice Address - Fax:602-589-0650
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-10-07
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant