Provider Demographics
NPI:1831130913
Name:TU, BAOLIEN NGUYEN (MD)
Entity Type:Individual
Prefix:
First Name:BAOLIEN
Middle Name:NGUYEN
Last Name:TU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 S DOUGLAS AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3224
Mailing Address - Country:US
Mailing Address - Phone:405-636-7220
Mailing Address - Fax:405-644-6950
Practice Address - Street 1:4200 S DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3223
Practice Address - Country:US
Practice Address - Phone:405-636-7220
Practice Address - Fax:405-644-6950
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19687174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE79275Medicare UPIN