Healthcare Provider Details

I. General information

NPI: 1548898448
Provider Name (Legal Business Name): THIEN VIET NINH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ROBIN AVE STE 11
HAMMOND LA
70403-5773
US

IV. Provider business mailing address

1430 TULANE AVE # 8050
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-1860
  • Fax: 985-230-1861
Mailing address:
  • Phone: 504-988-7809
  • Fax: 504-988-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number342455
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: