Healthcare Provider Details

I. General information

NPI: 1366440190
Provider Name (Legal Business Name): THANH-HUONG THI NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HELEN NGUYEN MD

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 N 36TH ST
SAINT JOSEPH MO
64506-2357
US

IV. Provider business mailing address

PO BOX 8095
SAINT JOSEPH MO
64508-8095
US

V. Phone/Fax

Practice location:
  • Phone: 816-279-1113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberR9975
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: