Provider Demographics
NPI:1508815929
Name:NGUYEN, HOAI NGHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:HOAI NGHIA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7452 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9393
Mailing Address - Country:US
Mailing Address - Phone:330-837-9249
Mailing Address - Fax:330-837-3054
Practice Address - Street 1:7452 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9393
Practice Address - Country:US
Practice Address - Phone:330-837-9249
Practice Address - Fax:330-837-3054
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072978207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2158221Medicaid
NG0898535Medicare ID - Type Unspecified
H09081Medicare UPIN