Provider Demographics
NPI:1518094424
Name:NGUYEN, OANH VAN (AP, DOM)
Entity Type:Individual
Prefix:MR
First Name:OANH
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47667
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-7667
Mailing Address - Country:US
Mailing Address - Phone:813-404-9522
Mailing Address - Fax:727-490-5768
Practice Address - Street 1:4180 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1113
Practice Address - Country:US
Practice Address - Phone:813-404-9522
Practice Address - Fax:727-490-5768
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP759171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist