Provider Demographics
NPI:1548209703
Name:NGUYEN, KHANH TUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:KHANH
Middle Name:TUNG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KHANH
Other - Middle Name:TUNG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7000 NORTH MOPAC
Mailing Address - Street 2:SUITE #420
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-482-0045
Mailing Address - Fax:512-476-9892
Practice Address - Street 1:7000 NORTH MOPAC
Practice Address - Street 2:SUITE #420
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-482-0045
Practice Address - Fax:512-476-9892
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75826208M00000X
TXN5908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098127Medicaid
IL833120OtherMEDICARE GROUP PTAN
ILR02522Medicare PIN
TXTXB110971Medicare PIN
IL036098127Medicaid
IL036098127Medicaid