1659415123 NPI number — THY BICH NGUYEN MD

Table of content: THY BICH NGUYEN MD (NPI 1659415123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659415123 NPI number — THY BICH NGUYEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
THY
Provider Middle Name:
BICH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659415123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10600 YORK RD STE 102
Provider Second Line Business Mailing Address:
FAMILY MEDICINE, LOWER LEVEL
Provider Business Mailing Address City Name:
COCKEYSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21030-2396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-318-4141
Provider Business Mailing Address Fax Number:
866-538-6990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10600 YORK RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COCKEYSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21030-2396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-318-4141
Provider Business Practice Location Address Fax Number:
866-538-6990
Provider Enumeration Date:
02/17/2007

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: 207Q00000X , with the licence number:  D66660 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: A104638 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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