Provider Demographics
NPI:1578595864
Name:NGUYEN, JOHN J (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12606 W HOUSTON CENTER BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2786
Mailing Address - Country:US
Mailing Address - Phone:281-495-7534
Mailing Address - Fax:281-575-1442
Practice Address - Street 1:12606 W HOUSTON CENTER BLVD STE 170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2786
Practice Address - Country:US
Practice Address - Phone:281-495-7534
Practice Address - Fax:281-575-1442
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161977703Medicaid
TXH96566Medicare UPIN