Organization
VIENNA DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAI HOANG NGUYEN M.D. (PHYSICIAN/OWNER)
(703) 281-3626
Entity
Organization
Contact information
Practice address
410 MAPLE AVE W STE 3, VIENNA, VA 22180-4224
(703) 281-3626
(703) 281-3615
Mailing address
410 MAPLE AVE W STE 3, VIENNA, VA 22180-4224
(703) 281-3626
(703) 281-3615
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0101244058
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A948510
—
CA
Enumeration date
09/20/2014
Last updated
09/20/2014
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