Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036138687 | IL |
Y | 111NI0900X | Internist | 036138687 | IL |
NPI | 1003259524 |
---|---|
Provider Name | Dr. Quang Tung Nguyen |
First Address | Rock Island, IL 61201 |
Second Address | Rock Island, IL 61201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 27/09/2017 |