Provider Demographics
NPI:1982411807
Name:NGUYEN, HAN NGOC (PHD)
Entity type:Individual
Prefix:
First Name:HAN
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13204 MOONLIGHT TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6711
Mailing Address - Country:US
Mailing Address - Phone:703-231-5604
Mailing Address - Fax:
Practice Address - Street 1:13204 MOONLIGHT TRAIL DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-6711
Practice Address - Country:US
Practice Address - Phone:703-231-5604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCER-100015-V1K4F2103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty