Healthcare Provider Details

I. General information

NPI: 1396307492
Provider Name (Legal Business Name): NGOC THANH TU NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TU NGUYEN MD

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHERIDAN SQ STE 200
KINGSPORT TN
37660-7435
US

IV. Provider business mailing address

4 SHERIDAN SQ STE 200
KINGSPORT TN
37660-7435
US

V. Phone/Fax

Practice location:
  • Phone: 423-246-7931
  • Fax: 423-246-1906
Mailing address:
  • Phone: 423-246-7931
  • Fax: 423-246-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number74419
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74419
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: