Provider Demographics
NPI:1700961315
Name:NGUYEN, DUNG CHI (MD)
Entity Type:Individual
Prefix:DR
First Name:DUNG
Middle Name:CHI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 FOREST RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-1078
Mailing Address - Country:US
Mailing Address - Phone:817-446-5277
Mailing Address - Fax:817-469-6378
Practice Address - Street 1:1102 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2534
Practice Address - Country:US
Practice Address - Phone:817-299-8100
Practice Address - Fax:817-469-6379
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK15872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096936202Medicaid
TX0076EAOtherBCBS
TXG38420Medicare UPIN
TX00822JMedicare PIN