Provider Demographics
NPI:1356685366
Name:THAI, NGUYEN SAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NGUYEN
Middle Name:SAM
Last Name:THAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:77036-4088
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:77036-4088
Practice Address - Country:US
Practice Address - Phone:713-777-7772
Practice Address - Fax:713-777-8642
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG9045208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127157903Medicaid