Provider Demographics
NPI:1750385688
Name:NGUYEN, DIANA KIM (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:KIM
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 1:3005 E RENNER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082
Mailing Address - Country:US
Mailing Address - Phone:972-699-0000
Mailing Address - Fax:972-699-0004
Practice Address - Street 1:3005 E RENNER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3573
Practice Address - Country:US
Practice Address - Phone:972-699-0000
Practice Address - Fax:972-699-0004
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0877207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX802791Medicaid
TX802791Medicaid