=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265774582
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HUNG NGUYEN MD, ABSA, CNIM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2013
-----------------------------------------------------
Last Update Date | 03/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6400 FANNIN ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-1521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-791-9778
-----------------------------------------------------
Fax | 281-564-9256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12314 TAMBOURINE DR
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-1267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-540-3658
-----------------------------------------------------
Fax | 281-564-9256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZE0600X
-----------------------------------------------------
Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
-----------------------------------------------------
License Number | 494
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------