Provider Demographics
NPI:1447357447
Name:NGUYEN, NHUNG KIM (MD)
Entity type:Individual
Prefix:
First Name:NHUNG
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 1009
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-765-5858
Mailing Address - Fax:225-765-5859
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 1009
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-5858
Practice Address - Fax:225-765-5859
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200813207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1584428Medicaid
LAI65419Medicare UPIN
LA1584428Medicaid
LA4K325D279Medicare PIN
LA4K325CQ60Medicare PIN