Healthcare Provider Details

I. General information

NPI: 1407388010
Provider Name (Legal Business Name): NGAN THI KIM NGUYEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE 2 SHORB TOWER
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-478-2400
  • Fax: 901-478-2220
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4469
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number20A17494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: