Provider Demographics
NPI:1497003602
Name:NGUYEN, DIEM HOANG (LOM)
Entity Type:Individual
Prefix:
First Name:DIEM
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17103-1839
Mailing Address - Country:US
Mailing Address - Phone:717-805-7776
Mailing Address - Fax:
Practice Address - Street 1:1847 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4825
Practice Address - Country:US
Practice Address - Phone:717-805-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM00059171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist