Provider Demographics
NPI:1942220520
Name:NGUYEN, QUANG T (MD)
Entity Type:Individual
Prefix:DR
First Name:QUANG
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-565-0999
Mailing Address - Fax:360-452-7303
Practice Address - Street 1:433 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6219
Practice Address - Country:US
Practice Address - Phone:360-565-0999
Practice Address - Fax:360-452-7303
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61210648207V00000X
MEMD16966207V00000X
ORMD215827207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1942220520Medicaid
ME1942220520Medicaid