=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558425256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAM VAN NGUYEN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 03/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3310 TRAVIS ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-520-7950
-----------------------------------------------------
Fax | 713-520-0610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2808 MILAM ST STE B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-3599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-520-7950
-----------------------------------------------------
Fax | 713-900-4067
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 12681
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------