MEDICARE: MINH-SON KHAC NGUYEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA16107	TX

General Provider Information

NPI Number	:	1306563580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINH-SON KHAC NGUYEN PA-C

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST STE 2300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1527
Country	:	US
Telephone Number	:	832-325-7280
Fax Number	:	713-512-7104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	09/07/2023

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