Provider Demographics
NPI:1588695241
Name:NGUYEN, SON T (MD)
Entity type:Individual
Prefix:
First Name:SON
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 W 147TH TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3673
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9301 W 74TH ST
Practice Address - Street 2:SUITE 225
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2207
Practice Address - Country:US
Practice Address - Phone:913-831-1003
Practice Address - Fax:913-831-4801
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33970208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200963830AMedicaid
43100011OtherBCBS KC
43100011OtherBCBS KC
ND1900293OtherMEDICA #
ND1900298OtherMEDICA #
ND21556OtherSIOUX VALLEY #
ND20010Medicare ID - Type UnspecifiedND MEDICARE #
ND142041OtherUCARE #
ND98D59NGOtherMNBS #
ND1900359OtherMEDICA #
ND11421Medicaid
ND20010OtherNDBS #
NDH30899Medicare UPIN
NDHP38399OtherHEALTHPARTNERS #
NDND200190OtherLHS #