Provider Demographics
NPI:1710026844
Name:NGUYEN, THUY TUONG (MD)
Entity Type:Individual
Prefix:DR
First Name:THUY
Middle Name:TUONG
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 1:6621 WESTBANK EXPY
Mailing Address - Street 2:SUITE D
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2658
Mailing Address - Country:US
Mailing Address - Phone:504-347-4688
Mailing Address - Fax:504-347-4698
Practice Address - Street 1:6621 WESTBANK EXPY
Practice Address - Street 2:SUITE D
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2658
Practice Address - Country:US
Practice Address - Phone:504-347-4688
Practice Address - Fax:504-347-4698
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.017072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1334227Medicaid
54353Medicare ID - Type Unspecified
LA1334227Medicaid