Provider Demographics
NPI:1225370596
Name:NGUYEN-LUU, PHUONG MINH (MD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:MINH
Last Name:NGUYEN-LUU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PHUONG
Other - Middle Name:MINH
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1330 PRUDENTIAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-4123
Mailing Address - Country:US
Mailing Address - Phone:214-879-3505
Mailing Address - Fax:214-879-3507
Practice Address - Street 1:3501 N MACARTHUR BLVD STE 310
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3651
Practice Address - Country:US
Practice Address - Phone:214-879-3505
Practice Address - Fax:214-879-3507
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2187207VG0400X, 207VX0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3795627Medicaid