Provider Demographics
NPI:1831137447
Name:NGUYEN, THU (MD)
Entity type:Individual
Prefix:DR
First Name:THU
Middle Name:
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 1:868 ULULANI ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3913
Mailing Address - Country:US
Mailing Address - Phone:808-961-5522
Mailing Address - Fax:808-961-0006
Practice Address - Street 1:868 ULULANI ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3913
Practice Address - Country:US
Practice Address - Phone:808-961-5522
Practice Address - Fax:808-961-0006
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10125207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08743802Medicaid
HI110236584OtherRAILROAD MEDICARE
HI00A0213692OtherHMSA
HIG64643Medicare UPIN
HIH101813Medicare PIN