MEDICARE: THIEN THANH K NGUYEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MED-PHYS-LIC-160586	MT

General Provider Information

NPI Number	:	1013476993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THIEN THANH K NGUYEN MD

Provider Business Mailing Address
First Line	:	1918 LA MAGNOLIA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-1191
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1918 LA MAGNOLIA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-1191
Country	:	US
Telephone Number	:	571-382-0175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	02/02/2026

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