Healthcare Provider Details

I. General information

NPI: 1700317120
Provider Name (Legal Business Name): TUNG NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12709 TOEPPERWEIN RD
LIVE OAK TX
78233-3258
US

IV. Provider business mailing address

12709 TOEPPERWEIN RD
LIVE OAK TX
78233-3258
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-3659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberU0167
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: