Provider Demographics
NPI:1326493941
Name:NGUYEN, THAO PHUONG (MD, BS)
Entity Type:Individual
Prefix:DR
First Name:THAO PHUONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 VALLEY VIEW LN STE 130
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-4929
Mailing Address - Country:US
Mailing Address - Phone:972-247-5464
Mailing Address - Fax:
Practice Address - Street 1:2914 VALLEY VIEW LN STE 130
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-4929
Practice Address - Country:US
Practice Address - Phone:972-247-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-12167207Q00000X
390200000X
TXT3346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program