MEDICARE: DR. KHOA DON 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	207Q00000X	Family Medicine Physician	L1144	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
2	8X6900	OTHER	TX	BLUE CROSS BLUE SHIELD TX

General Provider Information

NPI Number	:	1437146966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHOA DON NGUYEN MD

Provider Business Mailing Address
First Line	:	8313 SOUTHWEST FWY
Second Line	:	SUITE 105
City	:	HOUSTON
State	:	TX
Zip	:	77074-1611
Country	:	US
Telephone Number	:	713-773-1102
Fax Number	:	832-369-7355

Provider Business Practice Location Address
First Line	:	8313 SOUTHWEST FWY
Second Line	:	SUITE 105
City	:	HOUSTON
State	:	TX
Zip	:	77074-1611
Country	:	US
Telephone Number	:	713-773-1102
Fax Number	:	832-369-7355

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/11/2012

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