MEDICARE: HUY LE 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	207R00000X	Internal Medicine Physician	K3357	TX
2	208000000X	Pediatrics Physician	K3357	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023012002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUY LE NGUYEN MD

Provider Business Mailing Address
First Line	:	7355 N BEACH ST
Second Line	:	SUITE 153
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1897
Country	:	US
Telephone Number	:	817-984-7100
Fax Number	:	817-984-7099

Provider Business Practice Location Address
First Line	:	7355 N BEACH ST
Second Line	:	SUITE 153
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1897
Country	:	US
Telephone Number	:	817-984-7100
Fax Number	:	817-984-7099

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/05/2011

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