Healthcare Provider Details

I. General information

NPI: 1043450430
Provider Name (Legal Business Name): VAN VAN NGUYEN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8741 N LAMAR BLVD
AUSTIN TX
78753-5423
US

IV. Provider business mailing address

15604 HARRY LIND RD
ELGIN TX
78621-3824
US

V. Phone/Fax

Practice location:
  • Phone: 512-835-2345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberH5194
License Number StateTX

VIII. Authorized Official

Name: VAN V NGUYEN
Title or Position: PHYSICIAN
Credential:
Phone: 512-835-2345