Basic Information
Provider Information
NPI: 1467611582
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NGUYEN
FirstName: HOANG-LAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3571 W WHEATLAND RD
Address2: STE. 101
City: DALLAS
State: TX
PostalCode: 752373461
CountryCode: US
TelephoneNumber: 9722745555
FaxNumber: 9722745663
Practice Location
Address1: 3571 W WHEATLAND RD
Address2: STE. 101
City: DALLAS
State: TX
PostalCode: 752373461
CountryCode: US
TelephoneNumber: 9722745555
FaxNumber: 9722745663
Other Information
ProviderEnumerationDate: 06/04/2008
LastUpdateDate: 07/19/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XN0315TXN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RN0300XN0315TXY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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