Provider Demographics
NPI:1700175783
Name:NGUYEN, MY PHON THI (MD)
Entity Type:Individual
Prefix:DR
First Name:MY PHON
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PHON
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2653 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1647
Mailing Address - Country:US
Mailing Address - Phone:773-257-6672
Mailing Address - Fax:
Practice Address - Street 1:2653 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1647
Practice Address - Country:US
Practice Address - Phone:737-257-6672
Practice Address - Fax:773-257-5330
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI641202084P0800X
IL0361337982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry