Provider Demographics
NPI:1275823916
Name:NGUYEN, TAI ANH
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:ANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5671
Mailing Address - Country:US
Mailing Address - Phone:504-885-2505
Mailing Address - Fax:
Practice Address - Street 1:3848 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5671
Practice Address - Country:US
Practice Address - Phone:504-885-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA207302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program