Provider Demographics
NPI:1619930799
Name:NGUYEN, SON K (MD)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:K
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 1:1120 DENNIS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-1102
Mailing Address - Country:US
Mailing Address - Phone:713-759-0932
Mailing Address - Fax:713-759-0966
Practice Address - Street 1:1120A DENNIS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-1102
Practice Address - Country:US
Practice Address - Phone:713-759-0932
Practice Address - Fax:713-759-0966
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9040207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0060620OtherDPS
TXG9040OtherMEDICAL LICENSE
TX117862601Medicaid
TX117862601Medicaid
TXBN0155728OtherDEA
TXG9040OtherMEDICAL LICENSE