Basic Information
Provider Information
NPI: 1013639442
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NGUYEN
FirstName: CAT-TIEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2422 E 38TH ST
Address2:  
City: SAVANNAH
State: GA
PostalCode: 314043855
CountryCode: US
TelephoneNumber: 9122200485
FaxNumber:  
Practice Location
Address1: 1000 EISENHOWER DR STE H
Address2:  
City: SAVANNAH
State: GA
PostalCode: 314062601
CountryCode: US
TelephoneNumber: 9123351650
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/13/2022
LastUpdateDate: 09/13/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/13/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000XOT008596GAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


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