Provider Demographics
NPI:1215926480
Name:NGUYEN, LINH NGOC (DPM)
Entity type:Individual
Prefix:
First Name:LINH
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 N VILLAGE GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-7020
Mailing Address - Country:US
Mailing Address - Phone:504-227-2749
Mailing Address - Fax:504-263-1900
Practice Address - Street 1:775 BEHRMAN HWY
Practice Address - Street 2:STE B
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-3011
Practice Address - Country:US
Practice Address - Phone:504-227-2749
Practice Address - Fax:504-263-1900
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD218R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1541621Medicaid
LA480029699OtherRAILROAD MEDICARE
LA1248990001OtherPALMETTO
LA480029699OtherRAILROAD MEDICARE