Provider Demographics
NPI:1992075576
Name:DUNG X NGUYEN MD INC.
Entity type:Organization
Organization Name:DUNG X NGUYEN MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DUNG
Authorized Official - Middle Name:XUAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-473-7081
Mailing Address - Street 1:3736 S G ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-6725
Mailing Address - Country:US
Mailing Address - Phone:253-473-7081
Mailing Address - Fax:253-474-4756
Practice Address - Street 1:3736 S G ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-6725
Practice Address - Country:US
Practice Address - Phone:253-473-7081
Practice Address - Fax:253-474-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1020841Medicaid
WA1020841Medicaid
WAG001001483Medicare PIN