Healthcare Provider Details

I. General information

NPI: 1548209703
Provider Name (Legal Business Name): KHANH TUNG NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KHANH TUNG NGUYEN M.D.

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 NORTH MOPAC SUITE #420
AUSTIN TX
78731
US

IV. Provider business mailing address

7000 NORTH MOPAC SUITE #420
AUSTIN TX
78731
US

V. Phone/Fax

Practice location:
  • Phone: 512-482-0045
  • Fax: 512-476-9892
Mailing address:
  • Phone: 512-482-0045
  • Fax: 512-476-9892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA75826
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN5908
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: