Healthcare Provider Details

I. General information

NPI: 1578792495
Provider Name (Legal Business Name): HOANG NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

1653 W CONGRESS PKWY 654 PAVILION
CHICAGO IL
60612-3833
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-2533
  • Fax:
Mailing address:
  • Phone: 312-942-6800
  • Fax: 312-942-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2009017562
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number036-140355
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: