Provider Demographics
NPI:1063553501
Name:N.D. LIEN, P.C.
Entity type:Organization
Organization Name:N.D. LIEN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIEN
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-270-0290
Mailing Address - Street 1:PO BOX 29528
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30359-0528
Mailing Address - Country:US
Mailing Address - Phone:770-270-0290
Mailing Address - Fax:770-723-0598
Practice Address - Street 1:4865 LAVISTA RD
Practice Address - Street 2:SUITE A
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4436
Practice Address - Country:US
Practice Address - Phone:770-270-0290
Practice Address - Fax:770-723-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036656208D00000X
GA024046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1962443168OtherLIEN D. NGUYEN, MD
GA00258596BMedicaid
GA00614116CMedicaid
GA00735622CMedicaid
GA1154358760OtherDICH V. NGUYEN, MD,EMPLOY
GA01BDFZXMedicare ID - Type UnspecifiedDICH V. NGUYEN,MD, EMPLOY
GA580182910FMedicare ID - Type UnspecifiedLIEN D. NGUYEN,MD
GAF88641Medicare UPIN
GAD42458Medicare UPIN
GA00258596BMedicaid
GA00735622CMedicaid