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General NPI Number Information
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NPI Number | 1437440716
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Entity Type | Organization
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Legal Business Name | KHOA CAO NGUYEN MD PA
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 1340 S CONSTITUTION AVE
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City | ASHDOWN
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State | AR
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Zip | 71822-8652
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Country | US
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Telephone | 870-898-2007
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 S CONSTITUTION AVE
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City | ASHDOWN
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State | AR
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Zip | 71822-8652
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KHOA NGUYEN
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Credential | MD
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Telephone | 870-898-2007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C 5496
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License Number State | AR
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