Provider Demographics
NPI:1033606868
Name:NGUYEN, THOMAS D (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-739-3387
Mailing Address - Fax:419-251-0814
Practice Address - Street 1:3016 LONGTOWN COMMONS DR STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7849
Practice Address - Country:US
Practice Address - Phone:803-356-4712
Practice Address - Fax:803-356-0832
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC729213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program