Basic Information
| Provider Information | |||||||||
| NPI: | 1598753618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | DAN | ||||||||
| MiddleName: | THACH DAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1330 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730701330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053076668 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14101 PARKWAY COMMONS DR STE 103 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057752841 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 33676 | OK | Y | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | MD427147 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0700X | 31939 | DC | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | 095244 | 01 | PA | MEDICARE | OTHER | 1014302410001 | 05 | PA | MEDICAID | 696270 | 01 | OK | MEDICARE | OTHER |