Active NPI
Amanda M. Nguyen, MD
- Urology Physician
- Salt Lake City, UT
National Provider Identifier
1639819758
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 14162807-1205
- Practice address
- 50 N Medical Dr
Salt Lake City, UT 84132-0001 - Phone
- (801) 581-2121
- NPI assigned
- Mar 29, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 14162807-1205 | UT | Primary |
Addresses
Primary practice location
50 N Medical Dr
Salt Lake City, UT 84132-0001
Mailing address
30 Mario Capecchi Drive
Urology Room 4S148
Salt Lake City, UT 84112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241008002692 | UT | Order and Referring Only - Urology | 4789115247 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14162807-1205 | UT | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727049600000",
"number": "1639819758",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 MARIO CAPECCHI DRIVE",
"address_2": "UROLOGY ROOM 4S148",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 N MEDICAL DR",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841320001",
"telephone_number": "801-581-2121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "AMANDA",
"middle_name": "M.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-29",
"last_updated": "2024-09-23",
"certification_date": "2024-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "UT",
"license": "14162807-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.