Provider Demographics
NPI:1356870075
Name:NGUYEN, NGOC BAO THI (MD)
Entity type:Individual
Prefix:
First Name:NGOC
Middle Name:BAO THI
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 1:14024 QUAIL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1006
Mailing Address - Country:US
Mailing Address - Phone:405-419-8465
Mailing Address - Fax:405-419-7745
Practice Address - Street 1:4400 GRANT BLVD STE 103
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-0038
Practice Address - Country:US
Practice Address - Phone:405-467-5340
Practice Address - Fax:405-467-5341
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33120207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine