MEDICARE: UYENLY NGUYEN CNIM

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	2452	TX

General Provider Information

NPI Number	:	1457811879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UYENLY NGUYEN CNIM

Provider Business Mailing Address
First Line	:	2452 LAKEWOOD DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6800
Country	:	US
Telephone Number	:	469-343-5989
Fax Number	:

Provider Business Practice Location Address
First Line	:	12337 JONES RD STE 427
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4951
Country	:	US
Telephone Number	:	800-337-9007
Fax Number	:

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

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	08/11/2020

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Directions to “ UYENLY NGUYEN CNIM” Practice Location

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