Healthcare Provider Details

I. General information

NPI: 1629633474
Provider Name (Legal Business Name): MINH THU THI NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINH THI NGUYEN MD

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 WONDER WORLD DR STE 200
SAN MARCOS TX
78666-7502
US

IV. Provider business mailing address

950 E STATE HIGHWAY 114 STE 200
SOUTHLAKE TX
76092-5261
US

V. Phone/Fax

Practice location:
  • Phone: 512-754-8676
  • Fax: 512-371-6891
Mailing address:
  • Phone: 214-424-2200
  • Fax: 214-231-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberV5315
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: