Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 5101020457 | MI |
N | 207QG0300X | Family Doctor - Geriatric Medicine | BM9528324C166 | OH |
NPI | 1255777397 |
---|---|
Provider Name | Tuyen D Nguyen |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Byron Center, MI 49315-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2013 |
Last Update Date | 24/02/2021 |