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General NPI Number Information
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NPI Number | 1942629290
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Entity Type | Individual
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Provider Name | NHAN DAT PHAN NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 1430 TULANE AVE. SL-50
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City | NEW ORLEANS
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State | LA
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Zip | 70112-2699
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Country | US
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Telephone | 504-988-7809
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Fax |
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Provider Business Mailing Address
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Address Line | 8713 LINDENHURST PL
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City | TAMPA
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State | FL
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Zip | 33634-1088
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME139618
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License Number State | FL
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