=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063705390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSTON SURGICAL AND COSMETIC CENTER,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2011
-----------------------------------------------------
Last Update Date | 02/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9225 BOONE RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77099-2037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-933-1700
-----------------------------------------------------
Fax | 281-933-1705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9225 BOONE RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77099-2037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-933-1700
-----------------------------------------------------
Fax | 281-933-1705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CUONG XUAN NGUYEN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 281-933-1700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------