Provider Demographics
NPI:1689171019
Name:NGUYEN, DIEM-QUYNH PHUONG (MD)
Entity type:Individual
Prefix:DR
First Name:DIEM-QUYNH
Middle Name:PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIEM QUYNH
Other - Middle Name:PHUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:479-573-3082
Mailing Address - Fax:479-573-3100
Practice Address - Street 1:4620 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7961
Practice Address - Country:US
Practice Address - Phone:479-573-3082
Practice Address - Fax:479-573-3100
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-14544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty