Doctor Name: | KHOA C NGUYEN |
NPI Number: | 1700833134 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | C5496 |
Business Practice Address: | 1340 S Constitution Ave Ashdown, AR - 71822 |
Business Phone Number: | 8708982007 |
Business Fax Number: | 8708982575 |
Mailing Address: | Po Box 316, ASHDOWN |
State: | AR |
Postal Code: | 71822 |
Phone Number: | 8708982007 |
Fax Number: | 8708982575 |
NPI Enumeration Date: | 05/30/2006 |
NPI Last Update Date: | 01/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | C5496 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |