Provider Demographics
NPI:1487675898
Name:NGUYEN, KHANH (MD)
Entity Type:Individual
Prefix:
First Name:KHANH
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 1:1245 YALE ST UNIT A
Mailing Address - Street 2:HOUSTON
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-6959
Mailing Address - Country:US
Mailing Address - Phone:832-645-3337
Mailing Address - Fax:832-201-6932
Practice Address - Street 1:1245 YALE ST UNIT A
Practice Address - Street 2:HOUSTON
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-6959
Practice Address - Country:US
Practice Address - Phone:832-645-3337
Practice Address - Fax:832-201-6932
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8864207N00000X
CAA87643207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613930OtherMEDICARE PTAN
CA00A876431Medicare PIN