Healthcare Provider Details

I. General information

NPI: 1902082258
Provider Name (Legal Business Name): LAM D. NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 S MINGO RD
TULSA OK
74133-5710
US

IV. Provider business mailing address

9320 S MINGO RD
TULSA OK
74133-5710
US

V. Phone/Fax

Practice location:
  • Phone: 918-901-9701
  • Fax: 918-901-9702
Mailing address:
  • Phone: 918-901-9701
  • Fax: 918-901-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number4722
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: