Provider Demographics
NPI:1427035914
Name:YOUNG, NGUYEN TIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NGUYEN
Middle Name:TIEN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NGUYEN
Other - Middle Name:TIEN
Other - Last Name:DUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1004 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2748
Mailing Address - Country:US
Mailing Address - Phone:270-737-3866
Mailing Address - Fax:270-737-3868
Practice Address - Street 1:1004 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2748
Practice Address - Country:US
Practice Address - Phone:270-737-3866
Practice Address - Fax:270-737-3868
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20319207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64203193Medicaid
1436501Medicare ID - Type Unspecified
KY64203193Medicaid