1336710136 NPI number — PAUL NAM PHONG NGUYEN

Table of content: PAUL NAM PHONG NGUYEN (NPI 1336710136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336710136 NPI number — PAUL NAM PHONG NGUYEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
PAUL
Provider Middle Name:
NAM PHONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
PAUL
Provider Other Middle Name:
NAM PHONG
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1336710136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3606 NE AKIN DR UNIT C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64064-8016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-564-2552
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 LEES SUMMIT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64139-1246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-404-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  2021025316 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)