Provider Demographics
NPI:1659372258
Name:NGUYEN, ANH VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANH
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SCHOOL ST
Mailing Address - Street 2:SUITE 49
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4593
Mailing Address - Country:US
Mailing Address - Phone:281-351-9823
Mailing Address - Fax:281-351-7711
Practice Address - Street 1:455 SCHOOL ST
Practice Address - Street 2:SUITE 49
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4593
Practice Address - Country:US
Practice Address - Phone:281-351-9823
Practice Address - Fax:281-351-7711
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6467207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF27297Medicare UPIN
TX00J66ZMedicare ID - Type Unspecified