Provider Demographics
NPI:1659336931
Name:LE, TRUNG NGUYEN (MD)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:NGUYEN
Last Name:LE
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 1:2410 ELLA BLVD
Mailing Address - Street 2:STE. #A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2710
Mailing Address - Country:US
Mailing Address - Phone:713-426-6930
Mailing Address - Fax:713-426-6983
Practice Address - Street 1:2410 ELLA BLVD
Practice Address - Street 2:STE. #A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2710
Practice Address - Country:US
Practice Address - Phone:713-426-6930
Practice Address - Fax:713-426-6983
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF12477Medicare UPIN
TX8B2457Medicare ID - Type Unspecified