Provider Demographics
NPI:1558476382
Name:THU NGUYEN , MD, LLC
Entity Type:Organization
Organization Name:THU NGUYEN , MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THU
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-961-5522
Mailing Address - Street 1:868 ULULANI ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3913
Mailing Address - Country:US
Mailing Address - Phone:808-961-5522
Mailing Address - Fax:808-961-0006
Practice Address - Street 1:868 ULULANI ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3913
Practice Address - Country:US
Practice Address - Phone:808-961-5522
Practice Address - Fax:808-961-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08743802Medicaid
HI08743802OtherHMSA
HI08743802OtherHMSA
HIG64643Medicare UPIN