Provider Demographics
NPI:1508900523
Name:N.D. LIEN, P.C.
Entity Type:Organization
Organization Name:N.D. LIEN, P.C.
Other - Org Name:LAVISTA PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIEN
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-270-0290
Mailing Address - Street 1:PO BOX 29528
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30359-0528
Mailing Address - Country:US
Mailing Address - Phone:770-270-0290
Mailing Address - Fax:
Practice Address - Street 1:4865 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4436
Practice Address - Country:US
Practice Address - Phone:770-270-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00735622CMedicaid
GA1609819283OtherDR. CECILE NGUYEN
GAG44062Medicare UPIN
GA11BDLTMMedicare ID - Type UnspecifiedDR. CECILE NGUYEN