Provider Demographics
NPI:1447324785
Name:NGUYEN, CHI DANG (MD)
Entity type:Individual
Prefix:
First Name:CHI
Middle Name:DANG
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 1:4770 N EXPRESSWAY
Mailing Address - Street 2:STE 106
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526
Mailing Address - Country:US
Mailing Address - Phone:956-544-3336
Mailing Address - Fax:956-544-1705
Practice Address - Street 1:4770 N EXPRESSWAY
Practice Address - Street 2:STE 106
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:956-544-3336
Practice Address - Fax:956-544-1705
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1586207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0041AFOtherBCBS
TX141876100OtherVALLEY HEALTH PLANS
TX030272101Medicaid
0041AFMedicare PIN
TX141876100OtherVALLEY HEALTH PLANS
F20380Medicare UPIN