Provider Demographics
NPI:1235632027
Name:NGUYEN, CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9343 GARLAND RD APT 2424
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3724
Mailing Address - Country:US
Mailing Address - Phone:405-315-7807
Mailing Address - Fax:
Practice Address - Street 1:757 E US HIGHWAY 80 STE 200
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8741
Practice Address - Country:US
Practice Address - Phone:972-646-3346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2023-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU2589208000000X
GA88466208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program