Provider Demographics
NPI:1871786202
Name:WYN D NGUYEN MD PA
Entity type:Organization
Organization Name:WYN D NGUYEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WYN
Authorized Official - Middle Name:DINH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-918-9500
Mailing Address - Street 1:3013 E RENNER RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3576
Mailing Address - Country:US
Mailing Address - Phone:972-918-9500
Mailing Address - Fax:972-918-9501
Practice Address - Street 1:3013 E RENNER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3576
Practice Address - Country:US
Practice Address - Phone:972-918-9500
Practice Address - Fax:972-918-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4605208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty