Provider Demographics
NPI:1699790089
Name:NGUYEN, DANG (MD)
Entity type:Individual
Prefix:
First Name:DANG
Middle Name:
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 1:3702 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6302
Mailing Address - Country:US
Mailing Address - Phone:337-527-6530
Mailing Address - Fax:337-527-7337
Practice Address - Street 1:3702 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6302
Practice Address - Country:US
Practice Address - Phone:337-527-6530
Practice Address - Fax:337-527-7337
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1066281Medicaid
LA4K872BD22Medicare PIN
LAI60626Medicare UPIN
LA5BD22Medicare PIN
LA4K238Medicare PIN