Provider Demographics
NPI:1477551059
Name:NGUYEN, KHOA TRONG (MD)
Entity Type:Individual
Prefix:DR
First Name:KHOA
Middle Name:TRONG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 380
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3260
Mailing Address - Country:US
Mailing Address - Phone:281-895-8555
Mailing Address - Fax:281-895-8988
Practice Address - Street 1:920 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 380
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3260
Practice Address - Country:US
Practice Address - Phone:281-895-8555
Practice Address - Fax:281-895-8988
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-02-24
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXK1885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030273901Medicaid
TX0041BAMedicare PIN
TXG27786Medicare UPIN