MEDICARE: DR. PHONG HOAI NGUYEN M.D.

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	K5362	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	930091554	OTHER	TX	RAILROAD MEDICARE

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	8105J1	OTHER	TX	BCBSTX
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952345506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHONG HOAI NGUYEN M.D.

Provider Business Mailing Address
First Line	:	2430 NORTH FRY ROAD
Second Line	:	#100
City	:	HOUSTON
State	:	TX
Zip	:	77084
Country	:	US
Telephone Number	:	281-829-3999
Fax Number	:	281-829-5146

Provider Business Practice Location Address
First Line	:	2430 NORTH FRY ROAD
Second Line	:	#100
City	:	HOUSTON
State	:	TX
Zip	:	77084
Country	:	US
Telephone Number	:	281-829-3999
Fax Number	:	281-829-5146

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	05/26/2022

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