Provider Demographics
NPI:1861682247
Name:NGUYEN, BAOLUAN T (MD)
Entity Type:Individual
Prefix:
First Name:BAOLUAN
Middle Name:T
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 1:7329 W. VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-260-6363
Mailing Address - Fax:316-260-6301
Practice Address - Street 1:7329 W. VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-260-6363
Practice Address - Fax:316-260-6301
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1091162Medicaid
KS200566060 BMedicaid
KS003768013Medicare PIN