Provider Demographics
NPI:1659497451
Name:NGUYEN, CUONG DINH (MD)
Entity Type:Individual
Prefix:
First Name:CUONG
Middle Name:DINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 N PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6621
Mailing Address - Country:US
Mailing Address - Phone:405-217-8500
Mailing Address - Fax:405-217-8501
Practice Address - Street 1:1553 N PORTER AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6621
Practice Address - Country:US
Practice Address - Phone:405-217-8500
Practice Address - Fax:405-217-8501
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29620207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK00A1161380Medicaid
OK00A1161380Medicaid
OK285035Medicare PIN