=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659443190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C NGUYEN MEDICAL MANAGEMENT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 723 SHOTWELL ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77020-4813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-673-9400
-----------------------------------------------------
Fax | 713-673-9401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 723 SHOTWELL ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77020-4813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-673-9400
-----------------------------------------------------
Fax | 713-673-9401
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITTIONER
-----------------------------------------------------
Name | MRS. CHRISTINE NGUYEN-MOEN
-----------------------------------------------------
Credential | C-FNP
-----------------------------------------------------
Telephone | 713-673-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 646992
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------