Provider Demographics
NPI:1568827798
Name:NGUYEN, JIMMY TRI (DO)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:TRI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21800 KATY FWY STE 240
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7781
Mailing Address - Country:US
Mailing Address - Phone:346-387-7001
Mailing Address - Fax:346-387-7002
Practice Address - Street 1:21800 KATY FWY STE 240
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7781
Practice Address - Country:US
Practice Address - Phone:346-387-7001
Practice Address - Fax:346-387-7002
Is Sole Proprietor?:No
Enumeration Date:2015-12-14
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine