Provider Demographics
NPI:1679504377
Name:NGUYEN, HUNG THE (MD)
Entity Type:Individual
Prefix:
First Name:HUNG
Middle Name:THE
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 1:110 A EAST MAIN ST
Mailing Address - Street 2:PO BOX 464
Mailing Address - City:NORRIS CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62869
Mailing Address - Country:US
Mailing Address - Phone:618-378-3440
Mailing Address - Fax:618-378-3562
Practice Address - Street 1:110 A EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:NORRIS CITY
Practice Address - State:IL
Practice Address - Zip Code:62869
Practice Address - Country:US
Practice Address - Phone:618-378-3440
Practice Address - Fax:618-378-3562
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL400000635001Medicaid
IL09727246OtherBCBS
IL148968Medicare Oscar/Certification
F70833Medicare UPIN