MEDICARE: DR. DIEM-QUYNH PHUONG 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	207Q00000X	Family Medicine Physician	E-14544	AR

General Provider Information

NPI Number	:	1689171019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIEM-QUYNH PHUONG NGUYEN MD

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:	479-573-3082
Fax Number	:	479-573-3100

Provider Business Practice Location Address
First Line	:	4620 TOWSON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-7961
Country	:	US
Telephone Number	:	479-573-3082
Fax Number	:	479-573-3100

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

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	08/07/2025

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