Provider Demographics
NPI:1942261946
Name:NGUYEN-SIDDIQI, YUNG QUYNH (MD)
Entity Type:Individual
Prefix:DR
First Name:YUNG
Middle Name:QUYNH
Last Name:NGUYEN-SIDDIQI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:YUNG
Other - Middle Name:QUYNH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4902 EISENHOWER BLVD
Mailing Address - Street 2:SUIE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6344
Mailing Address - Country:US
Mailing Address - Phone:813-636-2000
Mailing Address - Fax:813-286-8835
Practice Address - Street 1:1910 JIM REDMAN PKWY
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7101
Practice Address - Country:US
Practice Address - Phone:813-754-4611
Practice Address - Fax:813-719-8731
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258348800Medicaid
H10953Medicare UPIN
FL49905WMedicare PIN