Healthcare Provider Details

I. General information

NPI: 1992209191
Provider Name (Legal Business Name): TAYSON NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
HAZARD KY
41701-9421
US

IV. Provider business mailing address

1430 TULANE AVE # SL50
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1331
  • Fax: 606-439-6682
Mailing address:
  • Phone: 504-988-7890
  • Fax: 504-988-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC5493
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: