Basic Information
| Provider Information | |||||||||
| NPI: | 1841441474 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | HUNG | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 MANATEE AVENUE WEST | ||||||||
| Address2: | ATT: IPM CREDENTIALING | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342058805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417482277 | ||||||||
| FaxNumber: | 9417488714 | ||||||||
| Practice Location | |||||||||
| Address1: | 316 MANATEE AVE W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342058805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417482277 | ||||||||
| FaxNumber: | 9417481958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207R00000X | ME102381 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | ME102381 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RI0011X | ME102381 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 012186600 | 05 | FL | MEDICAID | P01375248 | 01 | FL | RR MEDICARE | OTHER |