MEDICARE: KY Q 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	208000000X	Pediatrics Physician	10915R	LA
2	208000000X	Pediatrics Physician	M8212	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710903257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KY Q NGUYEN MD

Provider Business Mailing Address
First Line	:	6210 E HIGHWAY 290
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-1142
Country	:	US
Telephone Number	:	512-483-9596
Fax Number	:	512-406-6216

Provider Business Practice Location Address
First Line	:	10401 ANDERSON MILL RD STE 110B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78750-2579
Country	:	US
Telephone Number	:	512-250-5571
Fax Number	:	512-406-7300

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	04/01/2021

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Directions to “ KY Q NGUYEN MD” Practice Location

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