Healthcare Provider Details

I. General information

NPI: 1124555792
Provider Name (Legal Business Name): BAO NGOC DINH NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTY NGUYEN MD

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 03/03/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 FLOYD CURL DR
SAN ANTONIO TX
78229-3925
US

IV. Provider business mailing address

20509 HORNED OWL TRL
PFLUGERVILLE TX
78660-7801
US

V. Phone/Fax

Practice location:
  • Phone: 210-297-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPG183241
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS8349
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: