Active NPI
Dat Ly Nguyen
- Specialist
- Chicago, IL
National Provider Identifier
1487974689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 056007022
- Practice address
- 2649 S 75 TH Street
Chicago, IL 60649-3835 - Phone
- (773) 721-5845
- Fax
- (773) 721-5842
- NPI assigned
- Jun 10, 2010
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 056007022 | IL | Primary |
Addresses
Primary practice location
2649 S 75 TH Street
Chicago, IL 60649-3835
Mailing address
7855 South Shore Dr
3E
Chicago, IL 60649-5497
Phone (773) 721-5845
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056007022 | IL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276128000000",
"number": "1487974689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7855 SOUTH SHORE DR",
"address_2": "3E",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606495497",
"telephone_number": "773-721-5845",
"fax_number": "773-721-5842"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2649 S 75 TH STREET",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606493835",
"telephone_number": "773-721-5845",
"fax_number": "773-721-5842"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NGUYEN",
"first_name": "DAT LY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-10",
"last_updated": "2010-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IL",
"license": "056007022",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 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.