Provider Demographics
NPI:1487727376
Name:NGUYEN, THANH HANG KHAC (MD)
Entity type:Individual
Prefix:DR
First Name:THANH HANG
Middle Name:KHAC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 LOCKMEADE PL
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-5121
Mailing Address - Country:US
Mailing Address - Phone:813-440-0363
Mailing Address - Fax:813-925-6955
Practice Address - Street 1:2829 W. DELEON STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-342-1445
Practice Address - Fax:813-342-1449
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47549204F00000X, 208600000X
FLME99639208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
805T5NGOtherBLUE CROSS BLUE SHIELD
FL278977900Medicaid
FL02710OtherFLORIDA BLUE