Provider Demographics
NPI:1558465872
Name:NGUYEN, HONGYEN PHAM
Entity Type:Individual
Prefix:
First Name:HONGYEN
Middle Name:PHAM
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YEN
Other - Middle Name:PHAM
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7250 BARQUE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5867
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5306 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4829
Practice Address - Country:US
Practice Address - Phone:813-963-1900
Practice Address - Fax:813-963-1991
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL66692OtherBLUE CROSS BLUE SHIELD PROVIDER