Basic Information
Provider Information | |||||||||
NPI: | 1225106800 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NGUYEN | ||||||||
FirstName: | HUNG | ||||||||
MiddleName: | DINH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NGUYEN | ||||||||
OtherFirstName: | HONGHUNG | ||||||||
OtherMiddleName: | DINH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 99-712 PULUNIU LOOP | ||||||||
Address2: |   | ||||||||
City: | AIEA | ||||||||
State: | HI | ||||||||
PostalCode: | 967013590 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8084333006 | ||||||||
FaxNumber: | 8084331558 | ||||||||
Practice Location | |||||||||
Address1: | 1 JARRETT WHITE RD | ||||||||
Address2: | TRIPLER ARMY MEDICAL CENTER ATTN MCHK-QS | ||||||||
City: | TAMC | ||||||||
State: | HI | ||||||||
PostalCode: | 968595001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8084332460 | ||||||||
FaxNumber: | 8084331558 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/01/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | MD-10809 | HI | Y |   | Other Service Providers | Military Health Care Provider |   |
No ID Information.