Provider Demographics
NPI:1659475028
Name:NGUYEN, LINH BA (MD)
Entity Type:Individual
Prefix:DR
First Name:LINH
Middle Name:BA
Last Name:NGUYEN
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 1:8345 WALNUT HILL LN STE 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4245
Mailing Address - Country:US
Mailing Address - Phone:972-276-8688
Mailing Address - Fax:972-276-4473
Practice Address - Street 1:8345 WALNUT HILL LN STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4245
Practice Address - Country:US
Practice Address - Phone:972-276-6888
Practice Address - Fax:972-276-4473
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149213207RS0012X, 332B00000X
TXJ0159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ0159OtherLICENSE NUMBER
TX138717711Medicaid
TXF17834Medicare UPIN
TX138717711Medicaid