Healthcare Provider Details

I. General information

NPI: 1831417153
Provider Name (Legal Business Name): HAI NAM NGUYEN, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 AMELIA ST
GRETNA LA
70053-5533
US

IV. Provider business mailing address

1221 AMELIA ST
GRETNA LA
70053-5533
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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number023174
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06349R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP04172
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number023174
License Number StateLA

VIII. Authorized Official

Name: HAI NAM NGUYEN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 504-364-1844