Provider Demographics
NPI:1629167929
Name:NGUYEN, HUYEN THI (MD)
Entity Type:Individual
Prefix:DR
First Name:HUYEN
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 JUDSON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4103
Mailing Address - Country:US
Mailing Address - Phone:210-599-4086
Mailing Address - Fax:210-655-1401
Practice Address - Street 1:12501 JUDSON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-4103
Practice Address - Country:US
Practice Address - Phone:210-599-4086
Practice Address - Fax:210-655-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1486268-01Medicaid
TXG24163Medicare UPIN
TX8119B0Medicare ID - Type Unspecified