Active NPI
Dich Van Nguyen, MD
- Family Medicine Physician
- Tucker, GA
National Provider Identifier
1154358760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036656
- Practice address
- 4865 Lavista Rd
Tucker, GA 30084-4436 - Phone
- (770) 270-0290
- Fax
- (770) 723-0598
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036656 | GA | Primary |
Addresses
Primary practice location
4865 Lavista Rd
Tucker, GA 30084-4436
Mailing address
PO Box 29528
Atlanta, GA 30359
Phone (404) 766-4633
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000614116C | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036656 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291248000000",
"number": "1154358760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 29528",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30359",
"telephone_number": "404-766-4633",
"fax_number": "404-766-1108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4865 LAVISTA RD",
"city": "TUCKER",
"state": "GA",
"postal_code": "300844436",
"telephone_number": "770-270-0290",
"fax_number": "770-723-0598"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "DICH",
"middle_name": "VAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2010-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "036656",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000614116C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.