Healthcare Provider Details

I. General information

NPI: 1609667385
Provider Name (Legal Business Name): JUSTIN NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 ALAMEDA AVE
EL PASO TX
79905-2705
US

IV. Provider business mailing address

1850 OLD MAIN ST APT 1511
HOUSTON TX
77030-2222
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-1200
  • Fax:
Mailing address:
  • Phone: 469-301-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number20099321
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: