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NPI Code Detail

MEDICARE: DAT LY NGUYEN

MEDICARE:   DAT LY  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
1174400000XSpecialist056007022IL

General Provider Information

NPI Number : 1487974689
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAT LY NGUYEN
Provider Business Mailing Address
First Line : 7855 SOUTH SHORE DR
Second Line : 3E
City : CHICAGO
State : IL
Zip : 60649-5497
Country : US
Telephone Number : 773-721-5845
Fax Number : 773-721-5842
Provider Business Practice Location Address
First Line : 2649 S 75 TH STREET
Second Line :
City : CHICAGO
State : IL
Zip : 60649-3835
Country : US
Telephone Number : 773-721-5845
Fax Number : 773-721-5842
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2010
Last Update Date : 06/10/2010

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Directions to “ DAT LY NGUYEN ” Practice Location

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