Provider Demographics
NPI:1952718835
Name:NGUYEN, TUAN
Entity Type:Individual
Prefix:
First Name:TUAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13415 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-8729
Mailing Address - Country:US
Mailing Address - Phone:316-729-5204
Mailing Address - Fax:316-729-5208
Practice Address - Street 1:13415 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-8729
Practice Address - Country:US
Practice Address - Phone:316-729-5204
Practice Address - Fax:316-729-5208
Is Sole Proprietor?:No
Enumeration Date:2014-07-12
Last Update Date:2014-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist