Provider Demographics
NPI:1265753040
Name:NGUYEN, LAN T (MD)
Entity type:Individual
Prefix:DR
First Name:LAN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-006 NANA PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3644
Mailing Address - Country:US
Mailing Address - Phone:619-957-4907
Mailing Address - Fax:
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-366-8167
Practice Address - Fax:855-437-1594
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118694207R00000X
HIMD18631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine