MEDICARE: DIANA KIM NGUYEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	L0877	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750385688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA KIM NGUYEN MD

Provider Business Mailing Address
First Line	:	3005 E RENNER RD
Second Line	:	SUITE 100
City	:	RICHARDSON
State	:	TX
Zip	:	75082
Country	:	US
Telephone Number	:	972-699-0000
Fax Number	:	972-699-0004

Provider Business Practice Location Address
First Line	:	3005 E RENNER RD
Second Line	:	SUITE 100
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3573
Country	:	US
Telephone Number	:	972-699-0000
Fax Number	:	972-699-0004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	05/28/2010

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