Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | J6630 | TX |
NPI | 1013093749 |
---|---|
Provider Name | Yen Nguyen |
First Address | Arlington, TX 76010 |
Second Address | Arlington, TX 76010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133452602 | (05) | TX |
G32179 | (02) |