Healthcare Provider Details

I. General information

NPI: 1619945896
Provider Name (Legal Business Name): DOAN KHAC NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 FALLBROOK DR STE 100
HOUSTON TX
77065-4269
US

IV. Provider business mailing address

11301 FALLBROOK DR STE 100
HOUSTON TX
77065-4269
US

V. Phone/Fax

Practice location:
  • Phone: 281-807-5432
  • Fax: 281-807-5437
Mailing address:
  • Phone: 281-807-5432
  • Fax: 281-807-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberJ8690
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberJ8690
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: