Healthcare Provider Details

I. General information

NPI: 1699030775
Provider Name (Legal Business Name): NGOC-TUONG DINH NGUYEN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S 18TH ST
ALLENTOWN PA
18104-5622
US

IV. Provider business mailing address

1661 C 32ND ST SW
ALLENTOWN PA
18103
US

V. Phone/Fax

Practice location:
  • Phone: 610-628-8372
  • Fax: 610-628-8648
Mailing address:
  • Phone: 610-914-2215
  • Fax: 610-628-8372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS018280
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: