Provider Demographics
NPI:1598753618
Name:NGUYEN, DAN THACH DAM (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:THACH DAM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-1390
Mailing Address - Country:US
Mailing Address - Phone:405-601-2325
Mailing Address - Fax:405-497-6074
Practice Address - Street 1:1023 WATERWOOD PKWY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5324
Practice Address - Country:US
Practice Address - Phone:405-601-2325
Practice Address - Fax:405-497-6074
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK336762085R0202X, 2085N0700X
DC319392085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200794250AMedicaid
PA1014302410001Medicaid
OK696270OtherMEDICARE