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General NPI Number Information
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NPI Number | 1255764049
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Entity Type | Organization
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Legal Business Name | SAMUEL C NGWU, M.D.
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 5959 HARRY HINES BLVD STE 204
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City | DALLAS
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State | TX
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Zip | 75235-6234
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Country | US
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Telephone | 214-879-8820
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Fax | 214-879-6890
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Provider Business Mailing Address
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Address Line | 5959 HARRY HINES BLVD STE 204
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City | DALLAS
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State | TX
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Zip | 75235-6234
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Country | US
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Telephone | 214-879-8820
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Fax | 214-879-6890
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMUEL C NGWU
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Credential | M.D.
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Telephone | 214-879-8820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K2087
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License Number State | TX
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