MEDICARE: BAO NGUYEN

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	207RR0500X	Rheumatology Physician	Q3250	TX

General Provider Information

NPI Number	:	1336496892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAO NGUYEN

Provider Business Mailing Address
First Line	:	17931 BANDERA RIDGE LN
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-6996
Country	:	US
Telephone Number	:	832-279-2631
Fax Number	:

Provider Business Practice Location Address
First Line	:	10514 DUDE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-7133
Country	:	US
Telephone Number	:	832-279-2631
Fax Number	:

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

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	04/13/2023

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Directions to “ BAO NGUYEN ” Practice Location

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