Healthcare Provider Details

I. General information

NPI: 1619995768
Provider Name (Legal Business Name): KHANH-TRANG THI NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11920 ASTORIA BLVD STE 300
HOUSTON TX
77089-6097
US

IV. Provider business mailing address

11920 ASTORIA BLVD STE 300
HOUSTON TX
77089-6097
US

V. Phone/Fax

Practice location:
  • Phone: 281-481-8878
  • Fax: 281-481-9020
Mailing address:
  • Phone: 281-481-8878
  • Fax: 281-481-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLO878
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: