MEDICARE: DR. NGOC THANH TU NGUYEN MD

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician	74419	TN
2	207R00000X	Internal Medicine Physician	74419	TN

General Provider Information

NPI Number	:	1396307492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGOC THANH TU NGUYEN MD

Provider Business Mailing Address
First Line	:	4 SHERIDAN SQ STE 200
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-7435
Country	:	US
Telephone Number	:	423-246-7931
Fax Number	:	423-246-1906

Provider Business Practice Location Address
First Line	:	4 SHERIDAN SQ STE 200
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-7435
Country	:	US
Telephone Number	:	423-246-7931
Fax Number	:	423-246-1906

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

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	12/12/2025

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