Provider Demographics
NPI:1962480616
Name:NGUYEN, HIEP T (MD)
Entity Type:Individual
Prefix:DR
First Name:HIEP
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 1:1400 S DOBSON RD
Mailing Address - Street 2:CARSON CHILDREN'S MEDICAL CENTER
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4707
Mailing Address - Country:US
Mailing Address - Phone:857-488-1943
Mailing Address - Fax:
Practice Address - Street 1:1400 S DOBSON RD
Practice Address - Street 2:CARSON CHILDREN'S MEDICAL CENTER
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4707
Practice Address - Country:US
Practice Address - Phone:857-488-1943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221176208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2075211Medicaid
P3604365OtherOXFORD
0033264OtherNHP
1900467OtherUNI7
1900467OtherUNI1
30205178OtherWNH
AA14464OtherHPHC
Z11048OtherHEALT
000000028270OtherBMC
11273OtherHNE
80862OtherFCHP
1900467OtherMETRA
4656949OtherCIG2
469376OtherTUFTS
1900467OtherUNI4
3572875OtherAETPP
3572875OtherAETUS
4656949OtherCIG2