MEDICARE: SILVER STAR MEDICAL GROUP P A

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	L9394	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	801181163	OTHER	TX	SECRETARY OF STATE

General Provider Information

NPI Number	:	1710213350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER STAR MEDICAL GROUP P A

Provider Business Mailing Address
First Line	:	6892 SOUTHWEST FWY
Second Line	:	STE A-2
City	:	HOUSTON
State	:	TX
Zip	:	77074-2108
Country	:	US
Telephone Number	:	713-785-5900
Fax Number	:	713-785-5269

Provider Business Practice Location Address
First Line	:	6892 SOUTHWEST FWY
Second Line	:	STE A-2
City	:	HOUSTON
State	:	TX
Zip	:	77074-2108
Country	:	US
Telephone Number	:	713-785-5900
Fax Number	:	713-785-5269

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	GIAM NGUYEN
Credential	:	D.O.
Telephone Number	:	713-785-5900

Provider Enumeration Date	:	11/01/2009
Last Update Date	:	11/01/2009

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Directions to “SILVER STAR MEDICAL GROUP P A ” Practice Location

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