Provider Demographics
NPI:1699764407
Name:NGUYEN, ANH TAI (MD)
Entity type:Individual
Prefix:
First Name:ANH
Middle Name:TAI
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 1:1819 W 3500 S
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3457
Mailing Address - Country:US
Mailing Address - Phone:801-975-9707
Mailing Address - Fax:801-975-9373
Practice Address - Street 1:1819 W 3500 S
Practice Address - Street 2:SUITE 1C
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3457
Practice Address - Country:US
Practice Address - Phone:801-975-9707
Practice Address - Fax:801-975-9373
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176263-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT166Medicare ID - Type Unspecified
D07240Medicare UPIN