Healthcare Provider Details

I. General information

NPI: 1588778922
Provider Name (Legal Business Name): THANH-NHAN T NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD SUITE 11C
DALLAS TX
75216-7167
US

IV. Provider business mailing address

2914 WATERFORD DR
IRVING TX
75063-3192
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-1911
  • Fax: 214-857-2023
Mailing address:
  • Phone: 214-857-1911
  • Fax: 241-857-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ2235
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: