Provider Demographics
NPI:1316214968
Name:LONG NGUYEN, MD PLLC
Entity Type:Organization
Organization Name:LONG NGUYEN, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:LONG
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-682-8383
Mailing Address - Street 1:12515 BREE LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4765
Mailing Address - Country:US
Mailing Address - Phone:405-682-8383
Mailing Address - Fax:405-682-8044
Practice Address - Street 1:921 N.E. 13TH
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:OKLAHOMA CTIY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-682-8383
Practice Address - Fax:405-682-8044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty