Provider Demographics
NPI:1922209055
Name:NGUYEN, KEN T (MD)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5000 LAKE ST UNIT 7579
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-5348
Mailing Address - Country:US
Mailing Address - Phone:337-302-4239
Mailing Address - Fax:337-944-4421
Practice Address - Street 1:4200 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4118
Practice Address - Country:US
Practice Address - Phone:337-475-4748
Practice Address - Fax:337-944-4421
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.202580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ141182Medicare PIN