Individual
JACKSON NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
73277
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100099356
—
WI
Enumeration date
03/28/2018
Last updated
12/02/2024
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