Healthcare Provider Details

I. General information

NPI: 1891134250
Provider Name (Legal Business Name): CUONG DINH NGUYEN, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 N PORTER AVE
NORMAN OK
73071-6621
US

IV. Provider business mailing address

1553 N PORTER AVE
NORMAN OK
73071-6621
US

V. Phone/Fax

Practice location:
  • Phone: 405-217-8500
  • Fax: 405-217-8501
Mailing address:
  • Phone: 405-217-8500
  • Fax: 405-217-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number29620
License Number StateOK

VIII. Authorized Official

Name: DR. CUONG DINH NGUYEN
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 405-217-8500