Provider Demographics
NPI:1306827720
Name:NGUYEN S THAI
Entity Type:Organization
Organization Name:NGUYEN S THAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NGUYEN
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:THAI
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:713-777-7772
Mailing Address - Street 1:8250 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-4002
Mailing Address - Country:US
Mailing Address - Phone:713-777-7772
Mailing Address - Fax:713-777-8642
Practice Address - Street 1:8250 BELLAIRE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-4002
Practice Address - Country:US
Practice Address - Phone:713-777-7772
Practice Address - Fax:713-777-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9045261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB62170Medicare UPIN