Provider Demographics
NPI:1386796845
Name:NGUYEN, RAPHAEL TUAN (DPM)
Entity type:Individual
Prefix:DR
First Name:RAPHAEL
Middle Name:TUAN
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 1:7301 MISSION RD
Mailing Address - Street 2:STE 152
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3014
Mailing Address - Country:US
Mailing Address - Phone:913-432-2000
Mailing Address - Fax:913-432-2001
Practice Address - Street 1:7301 MISSION RD
Practice Address - Street 2:STE 152
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3014
Practice Address - Country:US
Practice Address - Phone:913-432-2000
Practice Address - Fax:913-432-2001
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200309213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY26580022OtherBCBS
KS6210240001Medicare NSC
KSS34A115Medicare ID - Type Unspecified
KS114130Medicare ID - Type Unspecified
U60796Medicare UPIN