Provider Demographics
NPI:1659387710
Name:NGUYEN, QUANG NGOC (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:QUANG
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300764
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-0764
Mailing Address - Country:US
Mailing Address - Phone:713-841-1246
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD - ECL 110
Practice Address - Street 2:MICHAEL E DEBAKEY VETERANS AFFAIRS MEDICAL CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-794-7381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03302363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical