Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 4626 | MN |
NPI | 1083831366 |
---|---|
Provider Name | Duylinh Pham Nguyen |
First Address | Brooklyn Park, MN 55445-2745 |
Second Address | Brooklyn Park, MN 55445-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |