Healthcare Provider Details

I. General information

NPI: 1235295551
Provider Name (Legal Business Name): HAI NAM NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WESTBANK EXPY
GRETNA LA
70053-5616
US

IV. Provider business mailing address

315 WESTBANK EXPY
GRETNA LA
70053-5616
US

V. Phone/Fax

Practice location:
  • Phone: 504-364-1844
  • Fax: 504-367-6022
Mailing address:
  • Phone: 504-364-1844
  • Fax: 504-367-6022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number023174
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number023174
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: