Healthcare Provider Details

I. General information

NPI: 1003545500
Provider Name (Legal Business Name): CASSIDY MINHHANH NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E 12TH ST STE 101
AUSTIN TX
78701-1955
US

IV. Provider business mailing address

313 E 12TH ST STE 101
AUSTIN TX
78701-1955
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-9699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10096873
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: