MEDICARE: LAN NGUYEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		OK

General Provider Information

NPI Number	:	1205766466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAN NGUYEN

Provider Business Mailing Address
First Line	:	11217 SW 30TH ST
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-1164
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 N BRADLEY ST
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-5229
Country	:	US
Telephone Number	:	580-772-3232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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Directions to “ LAN NGUYEN ” Practice Location

Language	Start Address	Practice Location

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