Healthcare Provider Details

I. General information

NPI: 1639339344
Provider Name (Legal Business Name): TUAN NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TUAN NGUYEN MD

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 E SHANNON WOODS ST STE 108
WICHITA KS
67226-4104
US

IV. Provider business mailing address

10100 E SHANNON WOODS ST STE 108
WICHITA KS
67226-4104
US

V. Phone/Fax

Practice location:
  • Phone: 316-282-3443
  • Fax: 866-550-5783
Mailing address:
  • Phone: 316-282-3443
  • Fax: 866-550-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-34689
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number04-34689
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number04-34689
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: