MEDICARE: THAI THANH 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	2024034688	MO
2	207Q00000X	Family Medicine Physician	MD-49609	IA
3	207Q00000X	Family Medicine Physician	036169694	IL

General Provider Information

NPI Number	:	1740740059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAI THANH NGUYEN MD

Provider Business Mailing Address
First Line	:	1004 CARONDELET DR STE 440
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4845
Country	:	US
Telephone Number	:	816-943-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 CARONDELET DR STE 440
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-4845
Country	:	US
Telephone Number	:	816-943-7777
Fax Number	:	816-943-7778

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

Provider Enumeration Date	:	03/22/2019
Last Update Date	:	05/07/2026

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