Provider Demographics
NPI:1639161870
Name:NGUYEN, NGOC-LOAN KHOA (DPM)
Entity Type:Individual
Prefix:DR
First Name:NGOC-LOAN
Middle Name:KHOA
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10419 COBALT FALLS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5440
Mailing Address - Country:US
Mailing Address - Phone:719-333-5042
Mailing Address - Fax:
Practice Address - Street 1:19121 W LITTLE YORK RD
Practice Address - Street 2:STE A
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5841
Practice Address - Country:US
Practice Address - Phone:719-333-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX1616213E00000X, 213ES0000X, 213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU94336Medicare UPIN
TX00697HMedicare PIN