Provider Demographics
NPI:1902275894
Name:NGUYEN, LANCE HUNG
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:HUNG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 STATE HIGHWAY 121 BYP
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4158
Mailing Address - Country:US
Mailing Address - Phone:469-948-1053
Mailing Address - Fax:
Practice Address - Street 1:851 STATE HIGHWAY 121 BYP
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4158
Practice Address - Country:US
Practice Address - Phone:469-948-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39400261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health