Provider Demographics
NPI:1619945896
Name:NGUYEN, DOAN KHAC (MD)
Entity Type:Individual
Prefix:DR
First Name:DOAN
Middle Name:KHAC
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 1:11301 FALLBROOK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4269
Mailing Address - Country:US
Mailing Address - Phone:281-807-5432
Mailing Address - Fax:281-807-5437
Practice Address - Street 1:11301 FALLBROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4269
Practice Address - Country:US
Practice Address - Phone:281-807-5432
Practice Address - Fax:281-807-5437
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8690207X00000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036EPOtherBLUE CROSS BLUE SHIELD TX
TX030253101Medicaid