Provider Demographics
NPI:1003027038
Name:NGUYEN, NINH HAM (DO)
Entity Type:Individual
Prefix:
First Name:NINH
Middle Name:HAM
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11302 FALLBROOK DR
Mailing Address - Street 2:STE 206
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4235
Mailing Address - Country:US
Mailing Address - Phone:832-604-3636
Mailing Address - Fax:281-469-8932
Practice Address - Street 1:11302 FALLBROOK DR
Practice Address - Street 2:STE 206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4235
Practice Address - Country:US
Practice Address - Phone:832-604-3636
Practice Address - Fax:281-469-8932
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015613207YX0905X
TXN8230207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB128813Medicare PIN