Provider Demographics
NPI:1396940946
Name:NGUYEN, HOANG DANG (MD)
Entity type:Individual
Prefix:DR
First Name:HOANG
Middle Name:DANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TIM
Other - Middle Name:DANG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 772
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-0772
Mailing Address - Country:US
Mailing Address - Phone:480-507-2199
Mailing Address - Fax:480-507-2218
Practice Address - Street 1:2451 E BASELINE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2471
Practice Address - Country:US
Practice Address - Phone:480-507-2199
Practice Address - Fax:480-507-2218
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0017416208000000X
AZ37837208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ307952Medicaid
948558127OtherMYUTMB 948558127-COMMERCIAL NUMBER