Provider Demographics
NPI:1972660678
Name:TUONG, VAN T
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:T
Last Name:TUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 EVERGREEN WYNDE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2619 EVERGREEN WYNDE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1370
Practice Address - Country:US
Practice Address - Phone:502-254-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080127646OtherRAILROAD MEDICARE
KY64024995Medicaid
2436295000OtherPASSPORT ADVANTAGE
1101539OtherPASSPORT
1101539OtherPASSPORT
KY64024995Medicaid