Basic Information
| Provider Information | |||||||||
| NPI: | 1033397187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | Y-UYEN | ||||||||
| MiddleName: | LE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 WALKER ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100134135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122268866 | ||||||||
| FaxNumber: | 2122262289 | ||||||||
| Practice Location | |||||||||
| Address1: | 268 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100133599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123796998 | ||||||||
| FaxNumber: | 2123796930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2008 | ||||||||
| LastUpdateDate: | 06/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 244330 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03017558 | 05 | NY | MEDICAID |