| Thien Long, Llc | |
|
4 Professional Dr Ste 133 Gaithersburg MD 20879-3426 | |
| (301) 974-9625 | |
| Not Available |
| Full Name | Thien Long, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4 Professional Dr Ste 133, Gaithersburg, Maryland |
| Authorized Official Name and Position | Stephen T Nguyen (SOLE OWNER) |
| Authorized Official Contact | 3019749625 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thien Long, Llc 4 Professional Dr Suite 133 Gaithersburg MD 20879-3407 Ph: (301) 974-9625 | Thien Long, Llc 4 Professional Dr Ste 133 Gaithersburg MD 20879-3426 Ph: (301) 974-9625 |
| NPI Number | 1174801609 |
|---|---|
| Provider Enumeration Date | 08/02/2011 |
| Last Update Date | 03/29/2012 |
| Medicare PECOS PAC ID | 5092977876 |
|---|---|
| Medicare Enrollment ID | O20120425000170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174801609 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D0063163 (Maryland) | Primary |
| Provider Name | Stephen T Nguyen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265596050 PECOS PAC ID: 3274564430 Enrollment ID: I20090430000448 |
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