Provider Demographics
NPI:1649359191
Name:NGUYEN, THUCDAN THUY (LAC)
Entity type:Individual
Prefix:MRS
First Name:THUCDAN
Middle Name:THUY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19420 GOLF VISTA PLZ
Mailing Address - Street 2:UNIT 230
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8265
Mailing Address - Country:US
Mailing Address - Phone:717-357-2089
Mailing Address - Fax:
Practice Address - Street 1:19420 GOLF VISTA PLZ
Practice Address - Street 2:UNIT 230
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8265
Practice Address - Country:US
Practice Address - Phone:717-357-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01126171100000X
VA0121000487171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist