Provider Demographics
NPI:1699107714
Name:NGUYEN, CANH TIEN (MD)
Entity type:Individual
Prefix:DR
First Name:CANH
Middle Name:TIEN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 SALT MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7075
Mailing Address - Country:US
Mailing Address - Phone:904-215-1171
Mailing Address - Fax:
Practice Address - Street 1:2173 SALT MYRTLE LN
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7075
Practice Address - Country:US
Practice Address - Phone:904-215-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine